World Health Organization (WHO) Coronavirus Press Briefing Transcript December 7

Fadela Chaib: (00:00) Hello, all. I am Fadela Chaib, speaking to you from WHO Headquarters in Geneva, and welcoming you to our global COVID-19 press conference today, Monday 7th, December. Present in the room is a WHO director general Dr. Tedros, Dr. Mike Ryan executive director health emergencies, Dr. Maria Van Kerkhove, technical lead for COVID-19 and Dr. Maria Angela Simo, assistant director general access to medicines and health products. Joining us remotely are Dr. Sumia Swaminathan, our chief scientist, Dr. Kate O'Brien director, immunization vaccines and biologicals, Steve Solomon, principle legal officer. Welcome all. As usual, we have simultaneous interpretation in the six UN official languages plus Portuguese and Hindi. Now, without further delay, I would like to hand over to Dr. Tedros for his opening remarks. Dr. Tedros, the floor is yours. Dr Tedros: (01:36) [foreign language 00:01:37]. Good morning, good afternoon, and good evening. Last week, I spoke about the importance of testing, which is vital for knowing where the virus is. But it's also important to know where the virus has been and how many people might have been infected without showing symptoms or being diagnosed by testing. To do that, seroprevalence studies are important, which look for antibodies in the blood of individuals to evaluate the extent of infection in different populations. Hundreds of seroprevalence studies have been done around the world, which vary in quality, methods and the type of tests used. Some follow people or populations over time to show how an antibody response in the individual or seroprevalence in populations change over time. Despite their limitations, their results are fairly consistent. They tell us that most of the world's population remains susceptible to infection with a COVID-19 virus. Dr Tedros: (02:49) We are still learning how strong immune responses are in different populations and for how long this immune response lasts. In January, WHO launched the unity studies, a global effort to standardize seroprevalence studies and the use of serological tests. So far, more than 60 countries, including more than 40 low and middle income countries are conducting one or more of these studies using WHO's protocols. We're providing technical, financial and operational support and building research capacities for these studies. We continue to work with our global networks to better understand the proportion of the world's population that has been exposed to this virus and how long immunity lasts in people who have been infected. Seroprevalence studies can help us to understand how long immunity from natural infection lasts, which could also help us to understand how long immunity from vaccination might last. As countries plan to roll out vaccines in the coming weeks and months, we urge them to prioritize vaccinating those most in need, based on the values framework and population prioritization roadmap issued by WHO's strategic advisory group of experts on immunization. Dr Tedros: (04:22) These documents provide recommendations on who should be considered for vaccination first and lays out the values that inform those recommendations. These are not easy decisions. Vaccinating health workers, who are at higher risk of infection will help to protect them and the health system. People at highest risk of serious disease or deaths as a result of age are also a high priority group, because protecting them will reduce severe disease and death and take the burden of health systems. As supply increase, the next groups would include those who have higher risk of severe disease because of their underlying conditions and marginalized groups at higher risk. In the initial stages of rollout, with only a small proportion of a country's population immunized, it's vital that governments, communities and individuals continue using proven public health tools. Shortly after my election as director general in 2017, we analyzed WHO's funding situation, and so that organization was too reliant on a handful of major donors. Dr Tedros: (05:49) In May, 2018. We announced our plans to establish a foundation to reduce that reliance by generating from new sources. In May of this year, I announced the creation of the WSU Foundation, a new independent body to generate resources for the work of WHO from sources. We have not accessed before. Today, the WHO Foundation announced the appointment of Anil Sony as its first chief executive officer from the beginning of next year. Anil is an experienced global health expert, with experience in the public, private and nonprofit sectors. Dr Tedros: (06:35) His previous role was at Viatris, a pharmaceutical company where he was head of global infectious diseases. He has also held senior leadership roles at the Clinton Health Access Initiative and the Global Fund to fight AIDS, tuberculosis and malaria. Anil will play a vital role at a vital time in supporting the WHO Foundation to achieve its goal of raising $1 billion for global health over the next three years. The foundation will also become a key partner of the COVID-19 Solidarity Response Fund, which has so far raised 238 million US dollars from more than 650,000 individuals, companies and philanthropies. I would like to thank the United Nations Foundation and the Swiss Philanthropy Foundation for their partnership in the success of the Solidarity Response Fund so far. And I'd like to congratulate Anil Sony, and we look forward to this exciting new era and implement the strategic solution that can bring better resources to WHO, I thank you. Fadela Chaib: (07:55) Thank you, Dr. Tedros. I will now open the floor to questions from journalists. I remind you that you will need to raise your hand, use the raise your hand function in order to get in the queue and please unmute yourself. I would like now to invite Carmen from Politico to ask the first question. Carmen, can you hear me? Carmen: (08:26) Yes, I can Fadela. thank you so much for giving me the question. I have the question about the WHO Foundation. And I was wondering, does the WHO framework for engagement with non-state actors apply to the who foundation? And where's the money coming from for the initial setup of the foundation? Who has finances so far so it can get on track? Thank you. Fadela Chaib: (08:57) Thank you, Carmen. I think we can also ... Dr. Tedros would like to say something. Dr Tedros: (09:09) Yeah. Thank you so much. I think as I said in my speech, maybe I can go back to how it all started. We did a diagnosis of the problems WHO has been facing, especially in 2017 and 2018 as part of our transformation. And we have concluded that from some of the problems, many of the problems could challenge, especially the financing part could challenge WHO's sustainability in terms of funding. As you know, from the volunteers, most of the money comes, 80% comes as volunteer financing, and it comes from few donors. And during that analysis, what we thought was if any of these donors withdrew its funding, WHO could get into shock which it cannot absorb. So the strategic solution at that time we proposed was for WHO to broaden its base of donors, but at the same time, find new areas of resources. Dr Tedros: (10:42) And that's why we developed the first ever investment case, the first resource mobilization framework, and also the first partner's forum which was in Sweden last year. And also, we decided to have the establishment of the WHO Foundation. So WHO Foundation was one of the solutions. So based on the first three, I think there are strategic areas that have been already covered. And the WHO Foundation focuses new areas of resources. So the money will come from areas where WHO cannot mobilize directly and where, like the principals we have in FENSA where there could be a conflict of interest. Dr Tedros: (11:41) So the WHO Foundation can mobilize resources without really direct involvement of WHO. So the relationship between WHO and what WHO Foundation makes is not direct. So one thing I would like to assure you that we have done all the assessments and based on FENSA, the foundations establishment is clear. So it's based on FENSA that the WHO itself, the foundation itself was established. But I just wanted to use this opportunity to tell you that WHO Foundation is one of the strategic solutions among others. Thank you. Fadela Chaib: (12:28) Thank you, Dr. Tedros. I would like now to invite Bianca Rovier from Global to ask the next question. Bianca, can you hear me? Bianca: (12:40) Hi Fadela, yes. Can you hear me? Fadela Chaib: (12:42) Yes, very well. Go ahead please. Carmen: (12:45) Thanks. So my questions to Global and correspondence here in Switzerland for Global. It's about to schools because contrary to what you have seen in most European countries during the second wave, some cities in Brazil, [inaudible 00:13:04] for example, are closing schools again, while shopping centers can still be open 24 hours a day. What are the WHO recommendations for our schools in countries facing a level of spread like Brazil is facing now again? And what have the most recent studies shown? What is the role of children interests, mission? I don't know how about the teachers and other staff, parents when they are going to pick them up? How important is this risk? Thanks a lot. Fadela Chaib: (13:42) Thank you, Bianca. Dr. Van Kerkhove will take this question. Dr. Van Kerkhove: (13:46) Thanks Bianca for this question. So WHO advises taking a risk based-approach as it relates to schools and considerations for schools and education systems, whether they remain open or closed. I think universally, everyone understands the critical importance of schools and education for children and young adults, especially the youngest kids. So in our guidance, which we've jointly issued with UNICEF, we're grateful for our partners at UNICEF and our global network or our strategic advisory group that helps advise us on educational settings, is to take this risk-based approach. And first and foremost, schools operate in communities. And if the virus is circulating in the communities and there's intense transmission in the communities, it's possible that the virus will enter into the school because individuals who work at the school, who attend the school live in those communities where the virus is circulating. Dr. Van Kerkhove: (14:42) So the first thing that needs to be done is to focus on reducing transmission in the communities. And there are a numbers of steps that you've heard us outline over time. But in the schools itself, we also outline guidance on how schools, what types of plans schools need to have in place in terms of the policies and plans for identifying cases. If they were to have a case, how they would carry out contact tracing. Having certain environmental cleaning within the school to make sure there's disinfection that's happening, certain physical barriers and distancing of desks, for example, to ensure that that children remain apart. Age appropriate use of masks, making sure that there's good ventilation and ensuring that there's good natural ventilation and having fresh air come into the schools. And making sure that part of those plans include communication, good communication with not only the students themselves who want to know what's happening and who are very, very smart, but also the parents of those schools and what role that they can play in this. Dr. Van Kerkhove: (15:41) And so we've outlined an approach to help schools in taking the decisions of when to open and when to close, if they need to move to a distance-based learning application or virtual type schooling. And so we've helped countries and decision-makers with taking those decisions at the most local level possible. Because the virus doesn't doesn't spread uniformly, there's different levels of intensity. And so that is something that's been issued and that's what countries are following. There's a lot of research that's happening now in looking at children and COVID-19 and the infection among children. Dr. Van Kerkhove: (16:20) And we do see some age differences in terms of the amount of infection identified in kids as measured by seroprevalence with the director general was talking about earlier in his speech. And there seemed to be lower levels of seroprevalence in the youngest age groups as compared to older children and teenagers. And we do also see differences in the rates of transmission. Amongst the youngest children, which seems to be lower compared to older children and teenagers who can spread more than the youngest kids, but we still have quite a lot to learn. Still we do see overall that children, when they are infected, tend to have more mild disease and asymptomatic infection. And that is something that has held true through the more and more research- Dr. Van Kerkhove: (17:03) ... infection. And that is something that has held true through the more and more research that is being published. But it isn't universal so we do have some children who have developed severe disease and we have had some children die. So it is really important that we take a risk-based approach. We look at schools as part of communities because it's not only the children, it's the people who work there. But there are many places all over the world that have opened schools and have prioritized keeping schools open while keeping transmission low. Fadela Chaib: (17:31) Thank you very much. I would like now to invite Emma Farge from Reuters to ask the next question. Emma, can you hear me? Emma Farge: (17:42) Yes, I can. Thank you for taking my question. It's regarding the Biden health team, which is coming together now. I'm wondering if WHO has had any discussions with the incoming administration and whether, specifically, you can update us on those discussions. Did they lead to anything significant on funding or even a possible late inclusion of the US into the COVAX Scheme? Thanks. Fadela Chaib: (18:13) Thank you, Emma. Dr Tedros: (18:22) As you know, they're in transition and the team is not formed in full. So there cannot be formal or organized discussions when they're doing their transition. So we will let you know when we have contacts, when we have formal engagements. But so far we haven't done any discussion with a group, as a group. As you know, some of them were just announced a few hours ago. Thank you. Fadela Chaib: (19:02) Thank you, Dr. Tedros. I would like now to invite Bloomberg to ask the next question, Corinne Gretler. Corinne, can you hear me? Corinne Gretler: (19:09) [inaudible 00:19:15]. Fadela Chaib: (19:30) Corinne? Corinne? [crosstalk 00:19:30] I can't hear you. Corrine? Okay. If not, I will go to the next journalist Gunilla von Post, which is journalist. Gunilla, can you hear me? Gunilla von Pos: (19:43) Yes, I can hear you. Can you hear me? Fadela Chaib: (19:44) Yes, very well. Go ahead Gunilla. Gunilla von Pos: (19:47) Thanks for taking my question. It concerns vaccine hesitancy. Now where we have the vaccines here, or very close, how worried are you, how concerned are you about this? And the fact that maybe too few people will actually vaccinate themselves to have a real impact on stopping the virus? And if I may ask a question concerning that connected to Sweden, where we had an experience from Swine Flu and the vaccinations that lead to lifelong disease of narcolepsy for hundreds of young people, how to address vaccine hesitancy that actually comes from a negative experience of mass vaccinations? And also from a vaccine that was developed extremely fast and keeping in mind that the pharmaceuticals right now, they do not know anything about the long-term side effects? Thanks. Fadela Chaib: (20:41) Thank you, Gunilla. I'd like to invite Dr. Kate O'Brien to take this question. Kate? Dr. Kate O'Brien: (20:51) Thank you. This is an extremely important issue and I'm really glad you've raised it. The vaccines that are demonstrating efficacy and are reaching authorization for use in countries, and we expect that we will see more of these, they're not going to be useful unless people actually become vaccinated. The vaccine that sits on the shelf or in a refrigerator or freezer is going to confer no benefit to people. The issue of vaccine hesitancy, and certainly the questions about the vaccine are really legitimate questions. And we do want people to be informed about the science. Dr. Kate O'Brien: (21:37) We want people to be fully informed about the evidence that regulators and policy-recommending bodies are reviewing in order to make the recommendations and the decisions that are being made. And I think one of the things that really helps communities and people, individuals who have to make decisions about being vaccinated, is the trust that they have in where the information is coming from. Dr. Kate O'Brien: (22:08) So information really does need to come from the most local level possible, from trusted providers, from people's physicians or the nurse that they go to, or the voice of public health people in the community. So sharing the information and the transparency that we have through the regulatory process and through the policy recommending process is really important, so that there's accuracy in what people understand about the vaccines. Dr. Kate O'Brien: (22:40) Each individual will make a decision for themselves about the value that they place on the vaccine. And especially in this time where so many people, millions of people, have suffered and the deaths that have occurred. I think this assessment that people will make about their understanding of the benefits of the vaccine is going to be a critical next phase in the pathway towards having these vaccines be critical tools in the toolbox of the interventions that we have. Dr. Kate O'Brien: (23:18) And as Mike and Maria have emphasized so often, having vaccines is not going to be a switch. It's not going to be just going from not having vaccines to having them. We're going to have to continue with the public health interventions for some time yet, because of vaccine supply and because of the ramp-up of people getting vaccinated. Dr. Kate O'Brien: (23:42) What I really want to emphasize here is that there is a very robust, a very strong safety monitoring system that is in place. And that system is in place in countries that will be starting vaccines in all countries around the world. And as WHO, and perhaps Mary Angela can speak to this a bit more, that safety system is switched on fully for full coordination across all of the different groups, the regulators, the manufacturers, WHO to be looking at the data in real time. So that if there are any signals of concerns around the vaccine, we have the ability to look at that, to investigate it and to really understand if there's any issue. Dr. Kate O'Brien: (24:37) But in the clinical trials, which have been very large in nature, the safety evidence is the critical piece of evidence that is being assessed by regulators, looking very carefully at the safety profile. And as you've seen in the trials that have been reported in the press releases, at least, there are tens of thousands of people who have been enrolled in the trials and each of them is randomized. So, approximately half of them have received the vaccine. So we have standards around safety. We have large clinical trials that have been done. We have a system in place to monitor for rare or unusual side, potential outcomes from the vaccine and assess whether they were related to the vaccine or not. Dr. Kate O'Brien: (25:37) I think we're where people really need to spend their time and their energy is on really being sure that the information that they're receiving is information that is based on the science. So, I wonder if Mary Angela wants to say anything more about the safety part or anybody else to come in here? Thank you. Fadela Chaib: (25:59) Thank you, Dr. O'Brien. I think it was a very comprehensive answer. I hope that Gunilla was happy. I would like now to invite NPR, Jason Beaubien from NPR to ask the next question. Jason, can you hear me? Jason Beaubien: (26:18) Yes, I can. Thank you. The CDC updated what they're calling a "close contact," and they're now adding anyone who had direct physical contact with a person. And before it was anyone who had been within six feet of someone for 15 minutes, masked or unmasked and I think there's still a little bit of confusion. What is your view about whether or not... They mentioned hugging, that if someone had hugged a person that person would then be considered a close contact and should quarantine. What would be your take on a short interaction like that? Just a hug. Would that be considered close contact? Dr. Van Kerkhove: (26:59) So thanks for the question. It's a good one because there are lots of different definitions out there for contacts. And what we understand from the way that... The reason you have the definition of contacts is because of the way the virus spreads. And it is a respiratory pathogen and so the virus can be released from your mouth and your nose when you talk or cough or sing. But can also be passed if people have direct contact with one another. Dr. Van Kerkhove: (27:24) What we learn about through these studies is to really get much more detail around what that contact entails. What we know is most transmission is happening among people who tend to spend a lot of time together. They happen in households, they happen in workplaces and so you have more than just a passing or a brief exchange between individuals. Dr. Van Kerkhove: (27:49) And so when you have a household contact you may hug that person, you may spend long periods of time in the same room together, you may sleep in the same bedroom together, you may share meals together. And so when that transmission happens in those households, it's very difficult to disentangle how transmission actually occurred in the instant of transmission. Dr. Van Kerkhove: (28:07) But we know that long periods of time together, the intensity of that type of interaction, meaning the closeness of it, the direct contact, the direct nature of that contact and the type of setting in which that transmission takes place. If it happens in a closed setting with poor ventilation, for example, that is a situation where transmission can be facilitated more readily. So we define a contact... We use a timeframe. We do give a 15 minute window in terms of that amount of time is spent with someone. But countries and institutions and agencies need to take decisions about how they define contacts based on the experience that they're seeing in their countries, based on the studies that are being conducted, the details of those outbreak investigation. Dr. Van Kerkhove: (28:54) This is why these outbreak investigations are so critical for us because you get to that level of detail that really disentangles how transmission is happening. Because there are different ways in which transmission can take place. So it is important, the time elements, the type of contact, if you're hugging someone, if you're kissing someone, if you're caring for someone, especially if they're sick, those are all really important to define contacts. Dr. Van Kerkhove: (29:18) Also, having said that, we try to outline what would be considered a higher risk contact versus a lower risk contact. And that relates to the amount of exposure, the duration and the time of exposure. Because when you're carrying out contact tracing, sometimes those numbers of contact become very high and you need to prioritize who you follow up. So we recommend following up the highest risk conacts, those that have the most exposure to someone who is a case. Dr. Michael Ryan: (29:51) Thank you, Maria. And I think Maria's spot on with that. And it's also just, for ordinary people out there, it's like looking at your skin in the sun. Some people can develop a growth, cancerous growth. Nobody knows which specific event caused that. But we do know if you spend longer in the sun, there's more of a chance that you will. But it's very difficult to associate a specific day or time at which that sunlight caused that cell to change and caused a... We do know it's bad to be out in the sun with unprotected skin. It doesn't mean that sunlight is bad. It means that overexposure to sunlight can lead to that outcome. Dr. Michael Ryan: (30:31) In the same way, we don't know what specific event causes the transfer of the virus to humans. It could be a home, but it's much more likely to occur in a situation where you're in the same space as somebody else for a long time, because there are more opportunities during that period for the virus to jump. Dr. Michael Ryan: (30:48) And I think it's difficult right now for the likes of CDC in Atlanta, the US is accounting for a third of all world cases at the moment, over the last number of weeks. The epidemic in the US is punishing, it's widespread. It's, quite frankly, shocking to see one to two persons a minute die in the US, a country with a wonderful strong health system, amazing technological capacities. Dr. Michael Ryan: (31:20) I believe that the CDC are doing their job. They're trying to identify each and every possible significant contact. They're really reaching out to try and get people to stay the course and to use the hope of vaccines. But just to remember, there are a number of months to go in which everyone is going to have to unfortunately avoid those hugs. And maybe because we're here talking today about hugs and about how much we would like those hugs over the holiday period and just how getting that close to people in a situation with intense community transmission can be so tragically dangerous. Dr. Michael Ryan: (31:55) And that's, I think, the awful brutal dilemma that we all face. It's a horrible thing to think that we would be here as the World Health Organization saying to people, "Don't hug each other." It's terrible. But that is the brutal reality in places like the United States right now. And I commend CDC for doing everything they can. Dr. Michael Ryan: (32:21) Definitions are definitions, at one level they're arbitrary. Who is the contact, who is not? What CDC are trying to do is pick out as many of the significant contacts as they can, so that people can protect themselves, get the diagnosis they need, get into treatment early. They're trying to make sure that people are detected and get access to care. They're trying to break the chains of transmission and I commend them as a strong federal agency, and as an agency that sends light to the world through its science for doing what they're doing. Fadela Chaib: (32:51) Thank you. I would like to call again Corrine Getler from Bloomberg News. A second attempt Corrine. Can you hear me? Corinne Gretler: (33:02) Yes I can. Can you hear me? Fadela Chaib: (33:06) Corinne? Corinne Gretler: (33:07) Hello? Fadela Chaib: (33:07) Yes. Yes. Corinne Gretler: (33:08) Can you hear me? Fadela Chaib: (33:09) Yes. Very well. Go ahead please. Corinne Gretler: (33:12) Okay. So I may have missed this in previous briefings, but I was wondering whether the WHO is advising member states to make the vaccine mandatory? Like what's your general stance on that? And if not countries, would it maybe make sense for companies to make it mandatory for employees? Fadela Chaib: (33:36) Thank you. Corrine. Dr. Simao? Dr. Mariangela Simao: (33:44) Let me start, and colleagues can compliment. Actually there are very few cases where vaccines are mandatory in countries, because countries have different regulations and they usually refer to vaccination in children. We don't have that experience with adults so far- Dr. Mariangela Simao: (34:03) We don't have that experience with adults so far, but we do believe that it's much better to work on information campaigns, on making the vaccine accessible to those priority groups who need to be vaccinated first, as we don't have enough vaccine next year to vaccinate the entire population. So, it will be up to countries to decide, but the position is that the way it works better is to make sure that people who are in the priority populations to be vaccinated first, that they have the right information and that they can do an informed choice regarding getting the vaccine. Fadela Chaib: (34:44) Thank you, Dr. Simao. I think Dr. O'Brien would like also to comment. Dr. O'Brien? Dr. Kate O'Brien: (34:52) Yes. I also just wanted to add to what Mariangela has said, is that there is only one vaccine, the Yellow Fever vaccine, that has any requirement regarding international travel. And obviously international travel, that's not a mandate to be vaccinated. It's an underpinning of that travel requirement. Just on the issue of mandatory vaccination, I fully agree with what Mariangela has had to say. There are some examples of countries, for the purpose of pediatric vaccinations, that have had success in assuring that children have high coverage with vaccination in a setting where there are school-related requirements for attendance. But we do think that it is a much better position to actually encourage and facilitate the vaccination without those requirements. And really, one of the limitations for vaccination is availability of vaccines. And that doesn't just mean in the country itself, but in a time and a place that is convenient for people to go get vaccinated, and with facilities that are of high quality that provide a positive environment for people to come and be vaccinated. Dr. Kate O'Brien: (36:24) So, there are many ways in which we can facilitate people coming to get the vaccines that they want to get and that they know are for their health and their safety. And I think the other thing to say is that there may be some countries or some situations in countries where there are professional circumstances where it would be required to be vaccinated or where it would be a highly recommended to be vaccinated. And one can imagine a certain professional jobs in hospitals, respiratory technicians, intensive care unit physicians and nurses, where for the safety of both the staff and the patients there would be a very strong recommendation to be vaccinated. So, I don't think we envision any countries creating a mandate for vaccination, but there certainly are situations where that strong recommendation, or perhaps on the part of an employer would decide that that would be a requirement. Thank you. Fadela Chaib: (37:37) Dr. Ryan? Dr. Michael Ryan: (37:38) Yeah. I agree with very much of what Kate said. I think the issue and the discussion we need to have amongst ourselves, with ourselves, is the issue of what is personal responsibility versus what is a requirement of law and what are you as an individual willing to do to protect yourself and those people around you? If I lived on a desert Island, would I necessarily want to have a COVID vaccine? I don't know, but if I was going to visit my 88 year old mother, she's not in a nursing home, but if she was, if vaccine was available, would I be responsible in going in there visiting lots of older people without being vaccinated, if a vaccine was available to me? So, I think we all have to ask ourselves those questions. And that's when you ask yourself those questions, you tend to come up with the right answers. And then, you avoid questions about law and mandatory natures of vaccines. Dr. Michael Ryan: (38:37) I think the other thing that MAria reflected to me earlier was the reality is most people want these vaccines. This is a massive potential victory for global health. People are demanding these vaccines. People want these vaccines. They want these vaccines to be rolled out carefully and safely, and Mariangela, Soumya, Kate and so many others working so hard here and around the world to ensure that process and give people the necessary reassurances. But the reality is the vaccine story is a good new story. It is the victory of human endeavor, potentially, over a microbial adversary as the DG has called it many times, and there's hope with that. And yes, we have to continue to bring people along on that journey, but I don't think we should necessarily focus on the negative aspects here. Dr. Michael Ryan: (39:29) We need to convince people and we need to persuade and we need to dialogue on this issue. I'm not a great believer. I agree with Kate, there are specific circumstances in which governments may have to require a specific mandates for vaccination, but I think all of us who work in public health would rather avoid that as a means of getting people vaccinated. I think we're much better served to present people with the data, present people with the benefits, and let people make up their own minds, obviously within reason because there are certain circumstances, as I've alluded to, where I would believe that the only responsible thing would be to be vaccinated in future when the vaccine is fully available. Fadela Chaib: (40:15) Okay, thank you. Kate, do you have something to add? Dr. Kate O'Brien: (40:21) Yes. I just wanted to add on the comment that I made, that there a limited number of countries that do have requirements for school attendance for children to verify the vaccination status. I'd like to also just comment that mandates have another side to them, which is that there are also examples where when countries thought that this would be a means to improve the coverage of vaccination in the country, it actually went in the opposite direction. And so, just reinforcing really what I said before and what Mike said, is that this is not a tool that has strong evidence behind it that it results in higher coverage in each circumstance where it has been tried. The evidence says that it actually goes in both directions. So, especially in the circumstance that we're in, and as Mike has said and Maria has said, the substantial majority of people are really eager to have these vaccines available and to move along with vaccination and access to vaccines. So, I don't think that mandates are the direction to go in here, especially for these vaccines. Thank you. Fadela Chaib: (41:45) Thank you all. I would like now to invite Kumar Bian, Indian Media, to ask the next question. Kumar, can you hear me? Speaker 1: (41:58) Yeah, can you hear me? Fadela Chaib: (41:59) Very well. Go ahead, please. Speaker 1: (42:02) See, right from the beginning, WHO has been saying, DG in particular, that the vaccine is very unpredictable. It behaves differently with different people. In this context, I would like to ask whether the WHO is looking at different vaccines for different age groups and geographies, because elders have different symptoms, the children have different systems. For I myself, I come out of COVID very recently. My age level, people have different symptoms. What's your take on it, WHO? Fadela Chaib: (42:35) Thank you, Kumar. Dr. O'Brien, can you take this question please? Dr. Kate O'Brien: (42:44) Sure. We have been emphasizing that in the evaluation of the vaccines, it is important that the trials are of large enough size and are of diverse enough populations that we can get some answers to questions about whether or not there is a difference in the efficacy of the vaccines according to different subgroups. So, age is one particular attribute that there is high interest in knowing whether or not the vaccines perform in the same way across different age groups. I want to emphasize that the data that has been made public at this point is from press releases. We're very eager to see the details of the data from these clinical trials. Some of the clinical trials are large enough and enrolled in a way that they are able to look at the efficacy of the vaccines according to some of the different age strata of interest. In particular, older adults, but none of the trials enrolled people who were over 80 years of age. So, we don't have information among the very oldest in our communities. Dr. Kate O'Brien: (44:02) What is available from some of the press releases are statements in the press release that the efficacy in older age groups was very similar, if not the same, as among the groups in the younger age groups. So, what we really need to wait for is to see the data both through the regulatory process and through the public processes where the data is provided. There are scientific reasons to ask the question about whether or not there could be differences of performance of vaccines in different age groups or underlying medical conditions. There are a number of areas in which one might expect that there could be differences in the performance of the vaccine. And as vaccines become used in communities, there will be ongoing evaluations of those vaccines as people become vaccinated to identify whether one or more of the vaccines has better performance or less good performance in some subgroups of people. Dr. Kate O'Brien: (45:16) It's also the reason why we need to continue the research on vaccines, that the story isn't over with the first vaccines coming to authorization, and there are a large number of vaccines in the pipeline. And it really is important that as we focus on ramping up both the manufacturing and the delivery, as vaccines come through and are assessed for authorization from a regulatory perspective, that we don't stop with the research. Because for most vaccines that we have, there has been ongoing development of them, and the ones that we started with at the beginning were improved upon over time. So, as much as we want the vaccines that are coming through now, I do want to emphasize the importance of the ongoing research. Thank you. Fadela Chaib: (46:08) Thank you, Dr. O'Brien. I'd like to invite Ana Maria Henao Restrepo, Dr. Ana Maria, to respond also to this question. Dr Ana Maria Henao Restrepo: (46:19) Yes. I just want to echo some of the points that Kate has highlighted. We have been discussing with clinical trialists and vaccine experts. And as Kate said, we are very pleased to have the short term information on the efficacy of these three vaccines, but all the experts agreed that we required to have additional evidence. Placebo controlled trials is the gold standard of obtaining information on the efficacy, the safety, the duration of the protection and the occurrence of serious adverse events. And this is why we are communicating to all the researchers around the world who are doing the trials to continue the trials as per the protocols. Dr Ana Maria Henao Restrepo: (47:04) Second, as it was said, randomized evidence is the best opportunity we have to evaluate the additional vaccines, and to know if these additional vaccines in the pipeline, we have almost 150 candidate vaccines all with different attributes. Some require one dose, some have different routes of administration, some are more suitable for certain contexts. We want to test all of them because maybe that will be the solution for countries or for certain locations. And certainly, we of course understand that at some point we are going to move into observational data, that randomized placebo controlled trials will not be any longer possible, but we have to enter into this phase understanding that this studies don't have the same attributes of randomized clinical trials, that even if they are very well conducted, they are subject to bias and interpretation is going to be more complex. So, we need to look at that. Having post-marketing surveillance, having case controlled studies, having cohort studies is a good idea, but we need to deliberate and we are in the process of organizing consultations to deliberate on whether the best context and the best approach is to conduct such studies so that we don't get the wrong answers. Fadela Chaib: (48:26) Thank you. I would like just to give you the title of Dr. Ana Maria Henao Restrepo. She's co-lead, research and development blueprint at WHO. Thank you so much for your answer. I would like now to invite the next journalist from [inaudible 00:14:47], Shuko. [inaudible 00:14:49], can you ask your question, please? Speaker 2: (48:54) Hello, WHO, can you hear me? Hello? Fadela Chaib: (48:59) Yes, I can hear you. Go ahead, please. Speaker 2: (49:00) Okay. Thank you for taking my question. So, tomorrow marks a year since the first patient was detected in Wuhan in China. Would you please give us an update on when WHO is planning to send the international experts to China? Does it take place by the end of this year, or rather the beginning of next year, or even later? Thank you. Dr Tedros: (49:30) Yeah. Thank you so much. So, we're planning and we're hoping to be on the ground as soon as possible. Thank you. Fadela Chaib: (49:44) Thank you. I would like now to invite Maya plants from the UN Brief to ask the next question. Maya, can you hear me? Carmen: (49:54) Unmute. Thank you very much [inaudible 00:49:59] for taking our question. My question is regarding the foundation. I know you have spoken already about it, but I would like to know what's in the pipeline for the coming year, for its very first year? Dr Tedros: (50:17) Yeah. Thank you so much. So, the board is established now and we have our CEO, as I have announced today and the foundation have already started taking the next steps, meaning raising the funding as operational costs for the foundation. And while raising that funding, of course it will trigger the ambitious three years plan the foundation has. So, while the immediate- Dr Tedros: (51:03) So, while the immediate funding will be the 40 million US dollars for the operation of the foundation, and then the plan is to mobilize a billion US dollars in the next three years. Thank you. Dr. Michael Ryan: (51:19) If I could just add, and this is more aspirational in terms of the foundation, because I've had the great pleasure of working on behalf of Dr. Tedros on the Solidity Fund for COVID, which is a precursor in a way for the hopes that we have for the foundation. Dr. Michael Ryan: (51:40) It's been very, very empowering this year to see how funding coming from sources other from traditional have funded so many amazing efforts in terms of the Solidity Fund that's invested in youth organizations for COVID messaging, it's invested in oxygen solutions and emergency medical team training in sub-regional centers in Ethiopia. It's involved funding our partners outside WHO more than our partners inside, including UNICEF World Food Program, UNRWA, UNHCR and others who are doing health-related activities in the field. Dr. Michael Ryan: (52:20) So, it is our hope, Dr. Tedros, that the foundation will be as you have laid out, a way in which WHO can leverage increased investment and health. And I think Tedros always says that this isn't about necessarily just increased investment in WHO, it's about leveraging more funding into the global cycle for health and driving partnership and innovation throughout the world. And I think we've started well with the Solidity Fund, and we hope that the foundation will have that same impact and I'm sure it will. Dr Tedros: (52:55) Thank you Mike. You have reminded me actually one thing. When we propose these strategy solution for WHO, it's not just to raise funding only. It could improve the amount of funding, it could improve the quality of funding, that's one. But at the same time, broadening our base and moving into additional resources, which doesn't have any strings attached, means improving also WHO's independence. So, it's not about funding only, it's also an independence issue. With long-term, multi-tier, broad-based funding comes independence also. So, it's not just finance, it's also ensuring and securing the independence of the organization, and that's why I said this is a strategy solution that addresses some of the systemic problems that we have. Thank you. Fadela Chaib: (54:07) Thank you, Dr. Tedros. I would like now to address Kostas from ART Greece to ask the next question. Kostas, can you hear me? Kostas: (54:22) Can you hear me? Fadela Chaib: (54:23) Very well. Kostas: (54:25) Yes. Thank you for taking my question. I would like to ask you about the origin of the coronavirus. Do you agree with the opinion, the scientific opinion of several virologists in the last days who claim that the virus did come from China but mutated in Italy, and then became more contagious and deadly than the original virus in Wuhan? Thank you. Fadela Chaib: (54:52) Thank you, Kostas. Dr. Ryan. Dr. Michael Ryan: (54:53) We can pass to Maria for more specific comment, but there are many, many hypotheses as to the origins, the evolution and the spread of COVID-19. They all make for great stories but at the moment there is no proof that any of the hypotheses for generation or for transmission are so. Dr. Michael Ryan: (55:17) But it is important that we continue to create those hypotheses and then test those against the data that we know. That's part of the reason why Dr. Tedros has pushed so hard to work with our Chinese colleagues in understanding the origins of the human disease in Wuhan. But we also have other data that we're looking at very closely for early transmission potentially in Europe. And also we've seen the human-to-mink-to-human transmission. So, what we see here is a very dynamic interface between animals and humans. We see evolution of the virus within human populations, and potentially even faster evolution within small animal populations that are densely packed together. Dr. Michael Ryan: (56:00) So, it is difficult to come up with a single hypothesis that explains transmission. There is no question that there was very explosive transmission in Wuhan in the early part of the epidemic, and clearly in Northern Italy a similar explosion of transmission at that time. And Italy suffered greatly for that. Then we saw the subsequent transmission in other countries. Dr. Michael Ryan: (56:23) So, it is an interesting observation around those effectively two epicenters and how they were related. But there are no answers to those questions. But we are really interested and we're working with both colleagues in Italy and other countries in Europe, and Denmark, we're working with our colleagues in China, and we would hope to build up a much more definite picture on that. So, please, keep sending us your hypothesis, but every hypothesis needs to be tested against the data that we actually have. Maria. Dr. Van Kerkhove: (56:53) Yeah, thanks. Just to support what Mike has said. The studies that need to take place in Wuhan, looking at the first cases that were detected, are really, really critical in terms of those epidemiologic investigations and really understanding at the time that the virus was detected. And those need to take place and those are taking place. And that's the main mission of the China international team and that's ongoing, as the Director General has said and as Mike has said. Dr. Van Kerkhove: (57:20) But we are a scientific organization, we are an evidence-based organization, we follow the science, we follow all of the research that is ongoing globally. And there are research groups that are looking at past serologic samples, SERA from 2019. And for all of those examples we will follow up and we're following up a recent publication from Italy and those samples are being retested by a partner lab. Dr. Van Kerkhove: (57:49) All of the sequencing that has been made available, and again it's incredible that more than 200,000 full genome sequences have been shared globally, and these have been shared on publicly available like GISAID. It's really incredible. We need more sequences to be shared, so thank you to colleagues for doing that. And looking at the most common ancestor and the evidence that points to a late November, early December most common ancestor. We're looking also at some countries that are looking at stored wastewater samples, and following up any indication of RNA testing and making sure that it's a real finding or it might be contamination. And we're looking at countries that are going back into their labs and looking at stored clinical samples from 2019. And so all of these avenues are followed up, but again, and the Director General has made very clear, and so has Mike and so have I, these studies will begin in Wuhan. It's really, really critical from a public health point of view to understand the events that took place because of the public health importance. What is really critical is that we understand the intermediate host, or hosts, because that is the important animal, or animals, that the virus can pass between and we want to make sure that that doesn't continue to happen or doesn't happen again. Fadela Chaib: (59:16) Thank you so much. I would like to invite Peter [Kiddie 00:59:20] from Anadolu News Agency to ask the last question. Peter, you have the floor. Peter Kiddie: (59:28) Thank you for taking my question. Do you hear me? Fadela Chaib: (59:34) Yes. Go ahead please. Peter Kiddie: (59:37) Thank you. With all the growing optimism from vaccine developed, there's also quite a lot of talk about the thorny issue of intellectual property rights and sharing of knowledge and data. And I know that South Africa and India have proposed to the WTO that they should choose whether to grant or enforce patents and other intellectual property related to COVID-19 and to share data. Now, the industry says with all the innovation it's pushed forward and such fast developed of data. Can you say what the WHO has to say about this? Thank you. Fadela Chaib: (01:00:22) Thank you, Peter. Dr. Simão. Dr. Mariangela Simao: (01:00:25) Thank you for the question. That has been coming up quite frequently lately, because these discussions are ongoing in the TRIPS Council, which is managed by WTO, as you know will. WHO of course welcomes all measures that countries can make in order to address any barriers to access to safe and effective products, right? Dr. Mariangela Simao: (01:00:52) And that's the spirit behind this process that's happening at the WTO. On the other hand, WHO's Director General together with the President of Costa Rica has launched at the end of May the COVID Access Technology Pool, which is aiming at increased sharing of knowledge in scientific information but also increase the pooling of patents, pooling of licenses through the Medicines Patent Pool. Dr. Mariangela Simao: (01:01:26) We believe very much that for next year, as we are facing a situation where we will have scarce products, scarce manufacturing capacity in countries, and that short-term we need to deal with the affordable access, equitable access to the products that prove to be safe and effective, on a medium and long-term we need to increase capacity for, for example, local production or technology transfer. Dr. Mariangela Simao: (01:02:02) And that's where this setup, which is this platform, can play a very important role through a voluntary mechanism where manufacturers and researchers, academics and institutions in general can deposit and make available the pertinent licensing or scientific knowledge that can help us face the pandemic in 2000, end of 2021, into 2022 and '23. Dr. Mariangela Simao: (01:02:33) And I'm saying this particularly because we have situations where we may have, for example, bio-therapeutics that could be useful to fight COVID but they are also being developed for other diseases. But for which, for example, monoclonal antibodies for which there is a very, very limited manufacturing capacity concentrated in some multinational companies at the moment. And we need to increase the willingness to do technology transfer and also to do the pooling of licensing so that we do not only address the COVID needs but we also address other conditions like oncologic products and HIV products for example. Thank you. Dr. Michael Ryan: (01:03:24) Thank you Mariângela. I fully agree with your points. But just from the perspective as we enter many holiday seasons now. Mariângela's right, the technology transfer can take time and it can be done over many products. But what we need now globally is not to enter the land of empty promises, in terms of supporting the ACT-Accelerator. The structure is there, the partnership is there. The means to do this, allocation fairly and equitably is there. We've never had that in place previously. Dr. Michael Ryan: (01:04:02) But what's not in place is the financing to make that happen in 2021. I'm not directly and daily involved with the ACT. I'm speaking as an advocate for my colleagues who've given every ounce of their energy across multiple organizations on this project over months. Quite frankly, right now there's too much of a gap between the rhetoric and the reality of what the Director General and other leaders have at their disposal in order to make the ACT-Accelerator deliver on a fair and equitable result for people around the world. Equity and fairness is still an aspiration, it's a dream, there's a plan. We have the architectural drawings for this moonshot. But I think the DG will agree, we still don't have the financing to make that happen. Dr. Michael Ryan: (01:04:54) So, I do think, as we approach the time of giving, it's really important that countries that speak to the idea of fairness and equity, countries that want that to be a reality and have the financial power, the donors that have the power, be they philanthropic or be they government or other, or private sector, that we actually make that happen. But anyway, that for me is going to be the essence of creating equity. It's not just about the technology itself, it's about financing the ACT-Accelerator, particularly the COVAX facility, in order to make this happen. Fadela Chaib: (01:05:33) Thank you so much. We have gone over one hour since we started this press conference. I would like to invite Dr. Tedros for any final comments. Over to you, DG. Dr Tedros: (01:05:46) Yeah. Thank you. Thank you so much, [Fadila 01:05:49], and thank you all for joining us and see you in our upcoming presser. Thank you. Have a nice week. Fadela Chaib: (01:06:00) DG, I would like just to remind journalists that we will be sending DG opening remarks and the audio file after this press conference. The full transcript will be available tomorrow on the WHO website. And as usual, don't hesitate to contact the media team for any follow-up question. Thank you and see you on Friday.