World Health Organization (WHO) Coronavirus Press Briefing Transcript November 16: Talk Moderna Vaccine

Varella: (00:39) Hello, everybody. I am [inaudible 00:00:42] speaking to you from the WHO headquarters in Geneva and welcoming you to our global COVID-19 press conference today, Monday 16, November. Present in the room is the WHO director general Dr. Tedros. In the room also Dr. Mike Ryan executive director health emergencies, Dr. Maria Van Kerkhove, technical lead for COVID-19. Dr. Maria Angela Simo, assistant director general access to medicine and health products. Dr. Ed Kelly, director of integrated health services and Mr. Steve Solomon, principal legal officer at WHO. Welcome all. As usual, we have simultaneous interpretation in six UN official languages plus Portuguese and Hindi. Now, without further ado, I will hand over to Dr. Tedros for his opening remarks. Dr. Tedros, you have the floor. Dr Tedros: (01:45) Thank you. Thank you [inaudible 00:00:01:47]. Good morning, good afternoon, and good evening. This is not the time for complacency. While we continue to receive encouraging news about COVID- 19 vaccines and remain cautiously optimistic about the potential for new tools to start to arrive in the coming months. Dr Tedros: (02:10) Right now, we're extremely concerned by the surge in cases we're seeing in some countries, particularly in Europe and the Americas. Health workers and health systems are being pushed to the breaking point. WHO has issued guidance and tools to increase capacity for the medical and public health workforce and supplies and facilities to manage COVID-19 patients. At present, WHO has 150 emergency medical teams, assisting countries in the planning and implementation of their emergency responses. WHO and partners are working with governments and health leaders to ensure that there is cover for health workers that are sick. That there are enough beds for COVID-19 patients and for essential services to continue safely. That there are enough masks, gloves, and other protective equipment. That governments have access to enough tests, therapeutics, and supplies to cope with demand now. And that health systems will be ready when safe and effective vaccines are rolled out. Dr Tedros: (03:33) Health workers on the front lines have been stretched for months. They're exhausted. We must do all we can to protect them, especially during this period, when the virus is biking and patients are filling hospital beds. In this moment, when some governments have put all of society restrictions in place, there is once again a narrow window of time to strengthen key systems. We have seen that those countries, which invested in case finding care and isolation, cluster investigations, adequate testing with rapid results, contact tracing and supported quarantine are facing much less disruption. Cluster investigations and contract contact tracing are part of the bedrock of a successful public response. These actions help prevent individual cases from becoming clusters and clusters, turning into community transmission. During recent Ebola outbreaks, the Democratic Republic of the Congo and WHO have invested in people and trained up a sizeable number of contact tracers who work closely with local leaders and communities. Dr Tedros: (04:59) And in just two days, in part down to active case finding and contact tracing, they will be able, I hope, to call an end to the most recent Ebola outbreak. As countries take extreme measures to curb the rapid spread of COVID-19, now is the time to invest in the systems that will prevent further waves of the virus. Invest in a well-trained and protected public health workforce so that you have enough contact tracers in place and ensure that those who are sick can isolate away from others and contacts are identified, notified, and managed properly. And where cases are starting to come down, keep investing so that you're prepared. This is a dangerous virus which can attack every system in the body. Those countries that are letting the virus run unchecked are playing with fire. First, there will be further needless deaths and suffering. Second, as we feature two weeks ago in a press conference, we're seeing a significant number of people experiencing long-term effects of the virus. Dr Tedros: (06:24) Third, health workers in particular are facing extreme mental health pressure and cases are severely burdening health systems in too many countries. Health workers went into medicine to save lives as you know. We must avoid putting them into situation where they have to make impossible choices about who gets care and who doesn't. We need to do everything we can to support health workers, keep schools open, protect the vulnerable and safeguarding the economy. From calling up students, volunteers, and even national guards to support the health response in times of crisis, to putting strict measures in place that allow pressure to be removed from the health system. There is no excuse for inaction. My message is very clear. Act fast, act now, act decisively. A laissez-faire attitude to the virus, not using the full range of tools available, leads to death, suffering and hurts livelihoods and economies. It's not a choice between lives or livelihoods. The quickest way to open up economies is to defeat the virus. Dr Tedros: (07:54) Last week, leaders came together at both the World Health Assembly and the Parties Peace Forum. High on the agenda was the act accelerator and ensuring equitable access to new rapid tests therapeutics, and COVID-19 vaccines. The European Commission, France, Spain, the Republic of Korea and the Bill and Melinda Gates Foundation placed 360 million US dollars to COVAXX, the vaccine's pillar of the act accelerator. New contributions bring the total committed to 5.1 billion US dollars. This is very substantial. But to ensure that tools are rolled out quickly across the world so that we save lives, stabilize health systems and drive a truly recovery, another 4.2 billion US dollars is needed urgently and a further 23.9 billion US dollars will be required in 2021. With countries spending three lends to prop up economies, COVAXX represents the best possible deal, as long as it will mean a quicker recovery for all and an end to stimulus. Dr Tedros: (09:26) G20 leaders will meet this weekend. This is an opportunity for them to commit financially and politically to the act accelerator and COVAXX, so that together we can end this pandemic quickly. It's also a moment for us to strive for the world we want. This cannot be business as usual. The time has come for a fundamental shift toward health being seen as an investment rather than a cost, and the foundation of productive, resilient, and stable economies. Health is central. To reflect this last week, I launched a new cancer council on the economics of health for all, to be chaired by distinguished economist, professor Mariana Mazzucato to put in person health coverage at the center of how we think about value creation and economy growth. Health, like the climate crisis, inequality and conflict, cannot be tackled in silos. A new collective way forward is needed to ensure that we deliver on the promises of the past and tackle these intertwined challenges together. I thank you. Varella: (11:01) Thank you, Dr. Tedros, for those remarks. I would like just to add an information we have with us, dr. Somia Swaminathan, chief scientist, and Dr. Kate O'Brien director, immunization vaccines and biological remotely. Now I would like to open the floor to questions from members of the media. I remind you that you need to raise your hand, use the raise your hand function in order to get in the queue to ask your question. I will start with Antonio Bronto from FH, the Spanish news agency. Antonino, can you hear me? Anotnia Bronto: (12:20) [foreign language 00:11:49] Varella: (12:28) Thank you, Antonio. Dr. Swaminathan, can you hear me? Dr Swaminathan: (12:36) Yes, I can. Thank you for the question. Varella: (12:48) We can see you. Dr Swaminathan: (12:54) Because there was an echo. I can start and maybe [inaudible 00:12:58] can come in. The question I think was about the news of the Moderna vaccine. Varella: (13:05) Yes, exactly. Dr Swaminathan: (13:06) That's quite encouraging. We just heard about the interim results from the press release from Moderna, it's a fairly detailed press release. And we know that in the interim analysis, it appears that the vaccine actually has a protective efficacy of over 90%. It's about 94%. Of course, we need to wait and see what the final efficacy and the safety profile of this vaccine will be when the whole data is analyzed after they reach their primary endpoint and also have enough followup of at least two months of half the trial participants for the side effects. And that will then be submitted to the regulatory agencies. As far as the COVAXX facility's concerned, we are working very closely with Gavi and SEPI. The facility- Dr Swaminathan: (14:03) I think very closely with Gavi and Sepi, the facility has been established and the facility is discussing with vaccine manufacturers from around the world. We are open to procurement of vaccine doses that are criteria of course, for the procurement. And there is an independent prioritization group that's been set up that will look at the dossiers, that will look at the data that manufacturers are submitting. And then there are the cost considerations as well, the affordability, and then there are practical considerations, like the need for cold storage, the number of doses of vaccine that will be required. The ease of the number of doses that may be available early in 2021. So they will be apart from efficacy and safety, other considerations that the facility will consider when making a decision on whether or not to go ahead with the contract. Dr Swaminathan: (15:02) So at this point, we cannot announce anything further about which companies. There are negotiations going on, of course, with several at the moment. And one very encouraging thing is to see that the case with the two MRNA vaccine results that we've heard, Pfizer and Moderna, that we seem to be achieving high efficacy, but there are many, many questions still remaining about the duration of protection, the impact on severe disease, the impact on different sub populations, especially the elderly, as well as the adverse events, beyond a certain period of time. So we also hope that the clinical trials will continue to collect data because that's really going to be important for us to know about in the long-term. And we're looking forward to getting more results in the coming weeks from the other vaccine trials that are currently in progress. Over. Varella: (16:06) Thank you, [Dr. Swaminathan 00:00:05]. Dr. O'Brien, do you have something to add? Dr. O'Brien: (16:15) Thank you. The only thing I would add to that really good explanation from Dr. Swaminathan is that the delivery characteristics of vaccines are also important. And we will be looking really carefully at the ease with which different vaccines can be delivered and certainly about the number of doses that are required. This is a two dose vaccine, and certainly any vaccine that can achieve a one dose vaccine is certainly easier to deliver than a two dose vaccine. And of course the cold chain characteristics are also important. So information from the Moderna vaccine about its requirements of both minus 20 and then refrigeration for a period of what they're indicating maybe a month period is welcome news as well. Varella: (17:07) Thank you, Dr. O'Brien. I would like now to invite Byron [Altuque 00:17:11] at Anadolu News Agency to ask the next question. Byron, can you hear me? Byron Altuque: (17:16) Hi, [Varella 00:10:15]. Thank you very much for giving me this opportunity and good evening, everybody. China seems to have recorded almost no new or very little case for a while, I mean, for months. Can we assume that Chinese authorities have successfully contained the virus to close in on them and the pandemic? If this is the case, what does the WHO attribute that success and what are the lessons learned from the rest of the world? There have also been unconfirmed reports of Chinese being much higher. So what would you like to say about this question? Thank you. Dr. MIchael Ryan: (18:02) Thank you for the question. Many countries have actually dealt with sometimes serious epidemics within their own countries and have found the comprehensive means by which to control the infection, test and trace context, quarantine context, treat their sick, and keep the virus once they've had it low, keep the virus at a very low level. China's amongst those countries, but others like Korea, Singapore, Japan, New Zealand, now Australia and others. So this has been a fight that many countries have taken to the virus. Dr. MIchael Ryan: (18:42) I think what's common in their approaches, while the approaches have been very different and they're in very different cultural settings, what has been common in their approach is really a relentless focus on doing it all. A relentless focus on mobilizing community action, like in Thailand with community-based surveillance and response. A relentless focus on testing, tracing and quarantine as you saw Australia really fight back against a very difficult epidemic in Melbourne and Victoria. The people of Victoria sacrificed 101 days, I think, in virtual lockdown, with ramping up of surveillance and they've turned the corner there significantly. Dr. MIchael Ryan: (19:24) So from that perspective, I think what we can see between countries is that capacity, both to chase the virus, take the fight to the virus, protect vulnerable groups, keep the health system ticking over, and when you get to that low level, following through with very aggressive measures, when cases and clusters occur, very good cluster investigation, like we've seen in places like Japan, both prospective contact tracing and retrospective investigation of cases to find out whether they were part of clusters. So much of that is the stuff we've been saying for months and months, a comprehensive strategy in controlling the virus aimed at protecting the vulnerable, aimed at saving lives. Dr. MIchael Ryan: (20:10) With regard to the other part of your question, with regard to current incidence in countries, I think many countries have very, very low numbers of cases. There's always the risk of importation of cases or undetected cases in any country. We have no evidence right now that the situation in China is anything other than extremely low levels of the virus with a very aggressive response to any up surges that you're seeing. Again, with much of the mass testing, that's gone on and mass testing is not something that's accessible to all countries. It takes a huge amount of resources to do. And for many countries that's not a feasible or even advisable option, but in the situations where it has been done, very few cases have actually been picked up as part of that mass testing. If there were a large number of undetected cases in the context of local transmission, one would expect to find cases through that process. So, no, we don't believe at this point that there's any evidence that points to a significant problem in China. Maria. Dr. Maria Van Kerkhove: (21:21) Yeah. Just to highlight the part of the question of what can we learn from others. I think that's exactly the right question we need to be asking and constantly asking, because there's so much that we're learning from each other. As Mike has pointed out, this is a comprehensive set of measures that China, that Japan, that Australia, so many countries, that Germany, that so many countries have been using right now. And I think some of the things that stand out is the doing it all, making sure that there's a comprehensive, aggressive approach in case finding, but using the system that's also in place to find cases that may be picked up in the community. So using your influenza surveillance system or your respiratory disease surveillance system that exists in country to also test a subset of those for COVID-19 are incredibly helpful to see if you might be missing chains of transmission. Dr. Maria Van Kerkhove: (22:09) And some of the things that work, you've heard us say many times before, arguably some of the most important things to do is to be able to isolate cases, really isolate those cases in a medical facility, if possible, in a community center that is specifically catered for COVID patients, depending on the severity of their systems, or if they need to be cared for at home, making sure that they're isolated from other family members. This is difficult to do in multi-generational homes or homes that have a lot of different people, but having a known case in the home, they need to be isolated from their loved ones. And that will really help break those chains of transmission. Dr. Maria Van Kerkhove: (22:47) The other thing is supported quarantine. So finding the contacts of the known cases and putting these individuals safely, securely, supported in a quarantine facility, or again, if they need to be quarantined at home, away from others. This is what breaks chains of transmission. Dr. Maria Van Kerkhove: (23:06) And in countries, the last thing just to highlight, one of the things we repeatedly see in countries is when you have a supported, enabled, empowered community to carry out individual level measures where they know, where I know, what do I need to do? What does my family need to do? What does my community need to do? All of that contributes to reducing the spread. And that is something we cannot emphasize enough because right now we need everyone, everyone everywhere, to really be doing what they can to make sure that they don't get infected themselves and to make sure that they don't pass the virus to someone else, should they either be infected or exposed. And so these are things that we need to continue to focus on and we will continue to put these messages out day in and day out. Varella: (23:59) Thank you. I would like now to invite [Gunilla 00:24:03] [inaudible 00:24:02] to ask the next question. Gunilla, can you hear me? Gunilla: (24:10) Yes, I can hear you. Can you hear me? Varella: (24:12) Yeah. Very well. Go ahead, please. Gunilla: (24:15) Thanks, Varella. Thank you for taking my question. It concerns Sweden. Sweden has had a very different strategy from the rest of the world until now, until today actually, when the government has introduced very, very tough restrictions, and it's basically the end of what's called the Swedish strategy. I'd like to hear what you think about this. Is this radical shift, is it a sign of a misunderstanding or miss judgment of what has been needed really to stop the virus and how useful can it be in this situation with a surge of cases to recommend the use of face masks in Sweden, which is basically the only country not recommending face masks. Thank you. Dr. MIchael Ryan: (24:57) I think all countries have had to adapt to the realities of this wave of transmission of the virus. I think it was quite clear in the first months of the spread of this disease, the [inaudible 00:25:14] had a major impact, the vast majority of people still remain susceptible to the virus in most cases, more than 90%. As the virus has spread again, particularly in the European region, and as people have suffered that fatigue of maintaining physical distance, wearing masks, hand-washing, not attending crowds and gatherings, it is difficult. It's difficult for all to maintain discipline and that self-managed discipline in that. The Swedish authorities had engaged and, I believe, very high levels of compliance with their original measures back in the spring and that social contract that exists in Sweden. The fact that the majority, I think over 50% of households in Sweden are single person households. They did see issues in long-term care facilities amongst some immigrant populations who live in multi-generational homes. So it wasn't without its difficulties. Dr. MIchael Ryan: (26:11) I think, this time round, Sweden has begun to implement and ask its population to do even more in terms of behavioral adaptation. And it has added into that some mandated measures. WHO's advice regarding mask wearing, I think is quite clear. Masks work. Masks work in particular environments where you can't maintain physical distance, where you're in a crowded setting. We would like people to look at all aspects of how you protect yourself. To look at your risk score in a sense on a weekly basis. You need to look at all of the activities in terms of the locations, the durations and the intensity of the contact you're going to have with people in those situations. There are many situations where wearing a mask is a very good addition to all of the other measures, maintaining physical distance and washing hands, avoiding crowded places. And in particular, linking the hand sanitization and hand washing to mask use as well. Dr. MIchael Ryan: (27:11) It's really important that people wear masks properly, use the right kinds of masks, but also wear masks properly fitted on their face and not under their nose. And also take care that when you're applying the mask and taking off the mask, you're using your hands. And therefore, that should always be done with proper regard for sanitization. So we would advise all countries in situations of widespread community transmission to consider the utilization of masks in those specific contexts where transmission risk is high. Dr. MIchael Ryan: (27:42) I'll pass to Maria for the specifics on that. But again, with regard, it's easy in all of these situations, countries are on the journey. And countries are trying to use the data as best they can to protect their populations. These decisions are made in good faith. They are evidence-based and they represent the considered view of people who- Dr. MIchael Ryan: (28:03) ... present the considered view of people who advise on policy. Adjusting and shifting and changing those policies is not a weakness. That's a strength. It takes courage sometimes to move away from a path and recognize that you have to add additional measures. That's not a failure, that's a sign that the system is capable of listening, adapting, and adjusting to new realities that you didn't expect to be the case. This is not a time, I believe, for recrimination. This is a time for solidarity, of moving forward together, finding the right combination of measures that works, and then implementing it in a consistent and fair fashion with the least recrimination possible, maintaining unity, if at all possible, between all sectors of society and government. Maria? Varella: (28:50) Okay. Thank you, Dr. Ryan. I would like now to invite [inaudible 00:28:57] from [foreign language 00:01:00] to ask the next question. Jeremy, can you hear me? Jeremy: (29:06) Yes, I can hear you, [inaudible 00:29:07]. Can you hear me? Varella: (29:08) Yeah. Very well. Go ahead, please. Jeremy: (29:12) A question, I would like to know what is the dominant feeling right now at WHO? Are you more amazed by the results of Moderna, Pfizer and the likes? Or are you more worried that those vaccines, if proven effective, will only be available in rich countries? Thanks. Varella: (29:34) [foreign language 00:01:38] Jeremy. Dr. Simão? Dr Mariângela Simão: (29:40) Let me start, and then Dr. Soumya can compliment. Of course we are very happy to hear positive results, but there are many vaccine candidates coming up with results before the end of this year, and beginning of next year. And some will be easier to implement at country level and some will be more challenging. But overall, we see landscape is very, very promising so far. And The fact that we have already two vaccine candidates that are showing interim results at 90, 94.5. If you could see results, it's quite, quite encouraging. Dr Mariângela Simão: (30:21) Of course, as I mentioned, there are challenges in the implementation, but we are also aiming with true the COVAX facility, in ensuring that countries will have a chance to, opportunity to, to have access to the vaccines they prefer in due time. And that we don't have a long legging period between this vaccines reaching developing countries and developed countries. Soumya, I don't know if you want to compliment. Varella: (30:54) Dr. Swaminathan? Go ahead, please. Dr Swaminathan: (30:58) Mariângela has answered the question. And we remain optimistic and we would like to work with all manufacturers and developers at the COVAX facility to ensure that we have the widest possible selection of candidates available. Because some candidates will suit more in certain situations, perhaps in certain subgroups, like the elderly. Some will have different storage conditions and so on. It would be good to really have a portfolio of products to fill that countries can also have some choice in the matter. But I think we're looking at, at least the first half of next year as being a period of very, very limited doses. Supplies are going to be limited. There are bilateral deals that many of the companies have done, so many of the doses have already been booked by some countries. We are hoping that there will be enough in the facilities so that the AMC countries, the 92 countries, with the AMC group will also get access to these doses at the same time. Dr Swaminathan: (32:11) But right now it's just a question of planning week by week and day by day. But our goal is to ensure that the highest risk people in all countries, Dr. Tedros mentioned the health workers were under tremendous strain, and are also being disproportionately affected by this pandemic. We want to make sure that these frontline workers, regardless of which country they're in, are protected. And that's our goal, and we're trying to work with all countries to see that this happens. But this, again, as Dr. Tedros had said many times, this requires noble solidarity, to really ensure that we achieve the goal of equitable access. Varella: (32:59) Dr. Ryan, please? Dr. MIchael Ryan: (33:00) Yeah, I think it's good for us too, to reflect on the amazing journey that we've all been on in terms of global science, and to reflect on the fact that before this pandemic started, as part of the research and development blueprint, we had target product profiles for coronavirus vaccines, for disease X, for therapeutics in the world. And many scientists have come together to agree on what we would need to be doing really quickly in the face of a pandemic. That transformed in February within a few days of Dr. Tedros Declaring the highest level of global alert into a research and development roadmap, which was the result of hundreds of scientists coming together under the leadership of people like Soumya, Mariângela, Maria, and so many others in the R&D who support the R&D blueprint. Dr. MIchael Ryan: (33:55) That roadmap then was as a blueprint to bring together technical partners. Dr. Tedros has been working at the political level on this issue since March, since April, talking to global leaders, going way, way back. Trying to build an Alliance and a coalition between multilateral organizations and powerful member states, to create the momentum that could drive this forward. But we are at that moment of great hope, but we need to hope with attitude. We need to hope with determination, with planning, with investment, with financing, with implementation, with readiness, the issues that Kate mentioned about getting countries ready to be able to deliver this vaccine to those who will benefit from it, and ensuring that's done with equity. Dr. MIchael Ryan: (34:36) So yes, it is a moment of, of great hope. And it is a moment that demonstrates what human civilization and what science can deliver, when it works across ideologic country boundaries, when it works towards a common good, a common goal, a global good. And when we see that happening, we should take hope from the science, solidarity and solutions. As Tedros has said almost every day at these press conferences. And he says that every day to us, that's what we have to focus on. And I think we should have hope, we should have realistic hope that we're not there yet. And a testament to everyone in COVAX and everyone in the R&D blueprint. Everybody who supports the work that Mariângela is doing, leading on allocation, on equitable allocation. We're not there yet, but I certainly would strike a note of hope in this regard. Varella: (35:30) Thank you all. I think Dr. Ed Kelley would like to add something. Dr. Edward T. Kelley: (35:36) Just really briefly on Mike's point that we're not there yet, but we're getting there. I think these points that we've raised earlier about the measures that need to be taken, continue to take now, and will be needed even after the vaccine is introduced. Last week, we had 60,000 deaths, we had 4 million new cases. We will have more of those weeks before the vaccine is out there. And I'm sure my partner Kate would mention what also Soumya and Mariângela mentioned, it's not vaccines that save people it's vaccinations that will actually save people. Dr. Edward T. Kelley: (36:12) The delivery function and the work on the ACT Accelerator is an important piece of that. We have spent recently work over the past two weeks plus to really integrate the work of the vaccines pillar of the ACT Accelerator with the health systems strengthening work, that they are working with the ACT Accelerator partners, as well as with the World Bank and really focusing on ramping up delivery in a hundred countries over the next hundred days to really look at how we can accelerate readiness. And I think that piece is going to be key. Varella: (36:45) Thank you. I would like also to ask Dr. Kate O'Brien who has something to add. Dr. O'Brien? Dr. O'Brien: (36:53) I really want to emphasize the great excitement there is, not only at WHO, but I'm sure around the world with the results that are coming out now from two phase three clinical efficacy trials. The part I really want to emphasize is we have plenty of vaccines that are life-saving vaccines. Measles is an example of that. A highly efficacious vaccine, over 95% efficacy, and yet we still have measles outbreaks. And so the importance of having achieved, obviously the data will need to be reviewed by regulators and a full analysis of the data needs to be taken, and these trials need to be completed as Soumya has emphasized. Dr. O'Brien: (37:35) But there was a really nice analogy recently about getting to vaccine efficacy is like building base camp at Everest. But the climb to the peak is really about delivering the vaccines. And this can not be overemphasized, that the people who need to receive these vaccines are the ones who really are the focus now, as we start to see that we have vaccines that that may in fact really have very strong efficacy. Dr. O'Brien: (38:06) The work is really beginning in every country around the world of exactly how are we going to manage in every country to immunize health workers? We don't have strong programs for immunization of adults in many, many countries around the world. This is really going to have to lean on the programs for immunization that we have in every country around the world, but they have largely focused on infants, children and adolescents. There's an enormous amount of work to do, and resources that will be needed to actually deliver the vaccines to everybody who needs these vaccines, should they, in fact, come forward as some of these press releases indicate they should. Varella: (38:54) Thank you all. I would like to give the floor to Tomo from Kyoto. Tomo, can you hear me? Tomo: (39:02) Yes. Can you hear me, [inaudible 00:39:03]? Varella: (39:03) Very well. Go ahead, please. Tomo: (39:06) Thank you, Dr. Tedros, congratulations that you're back in the actual podium, not virtual on this press conference. You have finally tested negative on the coronavirus. And another question if may too add, Dr. Kerkhove, we see the reports of Associated Press, that there's a cluster of infections going on in WHO. Could you collaborate for all you about how many cases in WHO headquarters and how serious the situation is. Thank you. Dr. Maria Van Kerkhove: (39:43) I will. Thank you, Tomo, for the question. It's nice to hear your voice again. Yes, as you know, as all workplaces, we are following infections and we're monitoring the health of all of our staff all over the world. We have had cases that have been staff members, and yes, I did also see the AP story. There have been 65 cases associated with HQ staff, headquarter staff, not all of which have been on the premises. There've been 36. Those 65 are from the start of the pandemic, so let us be very clear on that. And clearly the AP is reporting on an email that was sent to staff about that. Those are 65 cases reported since the beginning of the year. 36 have had access to the premises, who have been on the premises. Dr. Maria Van Kerkhove: (40:36) As I'm sure you know, we've greatly reduced our staff in the building. We're working in these different types of phases, depending on the epidemiologic situation in the areas that are around us as most workplaces are doing. And we have had some cases that have been associated with the premises. We do have some cases in the last week that are linked together. We don't know if they're an actual cluster. What we do is when we have any cases is we first make sure that they have access to a test, make sure that they have access to appropriate care, all are doing well, all have mild disease, or asymptomatic. And we are tracing back and we're also tracing forward. What we do is we carry out contact tracing to see who they came in contact with, to see if there are any further onward transmission, as most countries are doing. But we also look back to see what did they do in the previous 14 days, for example. Dr. Maria Van Kerkhove: (41:29) And so we do have cases that are linked within a team, but there are possible ways in which they were infected outside of the premises. So we're still doing the epidemiologic investigation with these individuals, but they are all doing well. And just for your information, we have initiated a number of practices in the building. Again, as all workplaces have with our physical distancing, with the use of masks, when we can't physical distance, making sure our ventilation is appropriate, making sure that we reduce the footprint on the campus, we limit our im... Dr. Maria Van Kerkhove: (42:03) ... make sure that we reduce the footprints on the campus. We limit our in-person meetings. We have utilized a lot of the different online platforms to have our meetings so that we continue to do the work that we do. We have tape on the floor that help us, where it's appropriate to sit, to make sure that we keep our spacing. We are constantly looking at the measures that we have in place. We adjust them as necessary and we will continue to do so. Thank you very much for the question and the concern for our staff. Dr. MIchael Ryan: (42:31) Yeah. I think also important to clarify that Maria, myself, Ted Ross or anyone at this table, we don't control the contact tracing or other processes in house. We don't get to say who stays or who goes. Dr. Tedros has stayed home, not because I told him or he told himself, but because our contact tracing teams made that decision. We have a special working group made up of key experts around the house. They decide, they investigate, they apply the principles of our standard operating procedures for managing cases in house. There's no policy discussion of someone should come in or should not come in. That is purely made on the basis of our SOPs and of science. That has worked very well and served us well over the last nine, 10 months. Dr. MIchael Ryan: (43:27) We also are able to increase and decrease the number of staff on site. We're able to increase and decrease the levels of restriction, which are commensurate with the local epidemiology and I can remind you that the Cantons of Vaud and Cantons of Geneva that's around us, have some of the most intense transmission in the world right now. Our staff are out there living in communities. To my knowledge the cluster being investigated is the first evidence of potential transmission on the site of WHO, but we can't completely protect ourselves from our own, as you, many out there, from your own social and other engagements with family and school and so many other things. We are human beings and we live within a society and we're not entirely within a cocoon here. I'll be glad to confirm that, as Maria said, I was joking with Ed beforehand, that we've significantly replaced the red tape with the yellow tape here at the WHO. Dr. Maria Van Kerkhove: (44:28) Sorry, I need to come back in because I'm being asked to clarify. When I said that there were 36 cases associated with the premises, that's since the beginning of the pandemic. There've been five cases testing positive in the last week. We just want to clarify that point, but also to say, as Mike said, we're normal human beings. We do our grocery shopping. We have to take our kids to school. We are living in an area right now that has very high incidents surrounding us and so we, as individuals, also need to take into the measures to keep ourselves safe. What we recommend to you and what you hear us saying every single day, is what we say to our own staff, to our loved ones, but just to clarify that it's been 65 cases associated with HQ since the beginning of the pandemic, 36 of which have had access to the premises and only five in the last week. Dr. MIchael Ryan: (45:18) Yeah. Could I just further clarify, Maria, because you used the word associate there. To all those amateur epidemiologists out there, that does not mean that transmission occurred on these premises. Those individuals were people who were designated as working onsite and therefore they left home to self isolate and their context traced outside. When we use the word associated, I'm sure we'll get a lot of feedback. This last cluster under investigation, to our knowledge, is the only evidence of our potential transmission on this campus over the last 10 months. Varella: (46:05) Thank you. Thank you both. I would like to know to call on Elana Gordon from the WGBH to ask the next question. Elana, can you hear me? Can you unmute yourself please, Elena? Elana Gordon: (46:24) Yes. Can you hear me? Varella: (46:25) Yes. Very well. Go ahead please. Elana Gordon: (46:28) My question and I hope that everybody is doing well, was related to this associated press cases that have been reported recently within the WHO. I wanted to follow up on that and ask, it was reported that a member of the leadership team had also tested positive and I wonder if you had more details about that and I hope that that person is doing well. Dr. Maria Van Kerkhove: (46:55) Again, there's no outbreak at HQ here, headquarters in Geneva. What we are doing, is we are actively monitoring the health and safety of all of our staff members. Every day, we fill in a questionnaire that asks how we're doing, that takes our temperature, where we are working and gives our contact information. If anyone fits a suspected case definition, they are followed up and they are tested and we make sure that people get the appropriate care that they need. We have been doing this since day one. Dr. Maria Van Kerkhove: (47:24) We have taken a number of steps to make sure that we reduce our opportunities for infection. We reduce the opportunities for any potential transmission in the building and elsewhere. This is something that we take very seriously as all workplaces do. Those who test positive is confidential, as is confidential in other locations as well, but the people who had tested positive in the last week are doing well. They are being followed up. They are resting comfortably at home. We're checking in on them every day and making sure that they have what they need and if they need any support, then we will drop off care packages if necessary and we are also making sure that those who are contacts have been identified and are also being supported in quarantine. That is something that we will continue to do until this pandemic ends. Varella: (48:18) Thank you. Dr. Kelley? Dr. Edward T. Kelley: (48:19) Just to add to that, since it's a question about leadership team, I think it's also important to add, last week we just completed the first fully digital world health assembly with all of our leadership participating, Dr. Tedros, obviously at a distance. As someone who's been here with the team since the beginning of the outbreak, I can tell you, as Mike says, the amount of yellow tape telling you which way to go up the corridor, which way to come down the corridor, where you can sit, where you can't sit, the amount of space in between, the amount of space shut down in terms of any eating establishment, the amount of cleaning that is happening in all of the offices, is exponential and has gone up during the time that we'd been here. We've also looked at an opportunity to really change the way WHO does its business, how it engages with countries, how it engages with senior leadership and how our leadership engages with them. I think those are also opportunities. Varella: (49:15) Thank The next question is for Agnès Pedrero from [foreign language 00:07:21]. Agnès? Can you hear me? Agnès Pedrero: (49:25) Yes. Hello. I can hear you. Hi everybody. Thank you for taking my question. It's just a follow-up of one question that was asked before from my colleague. It was just to know if a Dr. Tedros has been tested negative to come back to the headquarters? Thank you. Maybe I didn't listen the answer, but sorry. Thank you. Dr Tedros: (49:53) Thank you. First of all, I'm glad to be back and second working from home is very tough. Of course, I work on weekends and evenings even before COVID, during COVID, but when you do it during the working days, working hours from home, it's very, very difficult. Especially coordinating, running an assembly while under quarantine is very, very tough, as you can see. The most busiest two weeks while I was under quarantine because of the assembly, but at the same time, the most difficult, but I was okay, no symptoms. It's day 17 now and followed the protocols because of no symptoms and also the full followup of the protocol, I didn't see the need for testing. I can assure you that I'm okay and actually very, very busy. The most important thing is following the protocol. Thank you. Varella: (51:20) Thank you, Dr. Tedros. I think we are coming to the end of this press conference. Before I close it formally, I would like to invite Dr. Tedros for his final words. Dr. Tedros, the floor is yours. Dr Tedros: (51:37) Okay. Thank you. Thank you Fadela and thank you so much for those who have joined today and see you in our upcoming presser. Thank you. All the best. Varella: (51:52) Thank you, Dr. Tedros and colleagues for your participation and many thanks to journalists who are regularly following our press briefings and special thanks also to our...