World Health Organization (WHO) Coronavirus Press Briefing Transcript November 30

Tedros Adhanom Ghebreyesus: (00:00) It's welcome news, but it must be interpreted with extreme caution. Gains can easily be lost and there was still an increase in cases in most other regions of the world and an increase in deaths. This is no time for complacency, especially with holiday season approaching in many cultures and countries. We all want to be together with the people we love during festive periods, but being with family and friends is not worth putting them or yourself at risk. We all need to consider whose life we might be gambling with in the decisions we make. The COVID-19 pandemic will change the way we celebrate, but it doesn't mean we can't celebrate. We still can celebrate. The changes you make will depend on where you live. Always follow your local or national guidelines. Tedros Adhanom Ghebreyesus: (01:11) The first question to ask yourself is, do you need to travel? Do you really need to travel? For many people, this is a season for staying home and the saying safe. Celebrate with your household and avoid gatherings with many different households and families coming together. If you do meet people from a different household, meet outdoors if you can. Maintain physical distance and wear a mask. Avoid crowded shopping centers, shop at less crowded times and use online shopping if you can. If traveling is essential, take precautions to minimize the risk for you and others. Maintain distance from others and wear a mask when you're in airports and train stations and on planes, trains and buses, carry hand sanitizer with you or wash your hands frequently with soap and water. If you feel unwell, don't travel. Tedros Adhanom Ghebreyesus: (02:34) If we can't celebrate as normal this year, make a plan to celebrate with your family and friends once it's safe to do so. We know it will be safe. It's a matter of time. The pandemic will end and we all have a part to play in ending it. And we must remember that for millions of people, COVID-19 is only one health threat they face on a daily basis. Tomorrow is world AIDS day. The world has made incredible progress on HIV AIDS over the past 10 years. New HIV infections have declined by 23% since 2010 and age related deaths have fallen by 39%. A record 26 million people are on antiretroviral treatment, but the pace of increase has slowed and that leaves 12 million people who are living with HIV, but are not on treatment and 12 million is big. That gap is jeopardizing our goal of ending AIDS as a public health threat by 2030. Tedros Adhanom Ghebreyesus: (04:10) COVID-19 has had a profound effect on people living with HIV as it has for many diseases. There is some evidence is that people living with HIV may have an increased risk of severe disease and death from COVID-19. This increased risk has been compounded by disruptions to treatment for people living with HIV. In a WHO survey of 127 countries earlier this year, more than a quarter reported partial disruption to antiretroviral treatment for people with HIV. However, with support from WHO and the work of health and community workers, the number of countries reporting disruptions in HIV services has declined by almost 75% since June. This is a good news. Only the nine countries are still reporting disruptions and only 12 report a critically low stock of antiretroviral medicines. Tedros Adhanom Ghebreyesus: (05:24) This is mainly due to countries implementing WHO guidelines, including providing longer prescriptions of antiretrovirals for three to six months. No patients can avoid health facilities. WHO has also worked closely with manufacturers and partners to ensure adequate supply of treatment. Countries have also introduced a number of effective adaptations and innovations during COVID-19. In Africa, many countries have built their testing system for COVID-19 on the existing lab infrastructure for HIV and TB. In Thailand, the government has maintained pre-exposure prophylaxis services and telehealth counseling for men who have sex with men. And many countries have introduced more self testing for HIV to support self care and avoid the need for people to visit clinics or hospitals. Tedros Adhanom Ghebreyesus: (06:52) WHO is urging countries to maintain these innovations as part of the new normal and to help expand testing and treatment to people who need it. But if the pandemic has taught us anything, it's that in the face of an urgent health threat, the world can come together in new ways to defeat it. For many people, the pandemic is a source of fear but it can also be a source of hope that we can defeat COVID-19 and we can defeat HIV. And there is a lot of hope, especially with the advent of the vaccines that have been announced in the last few weeks. And from WHO side, we are sure that we can defeat this pandemic using the existing tools and also the vaccines that are in the pipeline. Tedros Adhanom Ghebreyesus: (08:07) The most important thing is we need to have hope and not only hope, but solidarity to work together to fight a common enemy using the existing tools and also the new announcements of vaccines in the pipeline. I thank you. But you Margarita, [foreign language 00:08:36]. Margarita: (08:39) [foreign language 00:08:41], Dr. Tedros. Now I will open the floor to questions. As I mentioned before, Dr. Magdoity is here. She's our director of our global HIV programs to answer your questions related to World AIDS Day tomorrow so please take the advantage of such expertise. We will as you know, I'm sure, use the raise your right hand icon to get in the queue to ask your questions and I would also have to remind you that we restrict this question to one per journalist. Though you have all been terrific about this. Without further ado, I will get the first question to common Carmen from Politico. Carmen, please unmute yourself and go ahead. Carmen: (09:24) Hi Margaret. Thank you. I do have a question for Dr. Mike Ryan. I was wondering if you could tell us at all the way the experts in the virus origin mission were selected, how many they are and if you can give us more or less a timeline of when the names will be made public. Thank you. Michael Ryan: (09:46) Hi. I think the names are public and the selection, we put out a call, I think for names and suggestions for the team. And the process was to select a diverse group of individuals representing a geographically diverse group who represent the necessary expertise. And that was really across veterinary science, medical science as well as laboratory science and especially people would have experience of investigations at the animal human interface. I'll pass to Maria if she has any supplemental, but it would have been very much the normal way. We pick expert groups in the way we select for missions in trying to balance the need for the highest quality individuals with their expertise, but also representing a broad diversity of geographies to represent the international community. In this regard. Maria. Maria Van Kerkhove: (10:52) There's not really much to add just to say they are online. We have made them available online. I think they've been up for a week or two. If not, we can provide the link to you if you don't know where those are. We also have published the terms of reference for the international team who have met and who continue to meet to make the plans. But as Mike has said, it's a diverse group of individuals with various technical backgrounds, a good geographic representation to make sure that they have the right technical background to be able to assist in the studies that are needed to evaluate the virus origins and the intermediate hosts. Tedros Adhanom Ghebreyesus: (11:30) Yeah. Thank you. That's a very important question and thank you so much, our colleague Politico. The terms of reference has been announced, posted. The names of experts have been announced and I would like to assure you that WHO's position is very, very clear. We need to know the origin of this virus, because it can help us to prevent future outbreaks and we're doing everything to make sure that we know the origin and this is a technical issue. And I would like to say, some have been politicizing this, although we have been doing our best to know the origin, but some have been politicizing it. Tedros Adhanom Ghebreyesus: (12:42) WHO's position has been very clear that we will start the study from Wuhan, know what has happened there and then based on the findings we have there to explore if there are other avenues that we have to explore. And our position has been very clear and very strong and we're working to make sure that the origin of the virus is known because it helps the world to understand the genesis and prevent future outbreaks. This is not for WHO alone to work with on, by the way. We're working with FAO, we're working with OIA and in the expert team, we have representatives from WHO, from FAO, from OIA and we have international experts from various countries. From the UK, from the United States, from Japan, from South Korea, from Sudan, you name it, but it's already posted. One thing we would like to advise... Tedros Adhanom Ghebreyesus: (14:03) ... So, one thing we would like to advise is that, please let's not politicize this. We're doing everything we can based on science. And what has been a barrier and trying to derail us from what we have been doing scientifically was the politicization of the study of the origin of the virus from some quarters. But WHO is committed to do everything it can, based on science and solutions, to find the origin. And that's the basics. We need to do the basics. And we will not stop from knowing the truth on the origin of the virus, but based on science, without politicizing it or trying to create tension in the process. Tedros Adhanom Ghebreyesus: (15:05) And we call upon everybody actually to cooperate on this. And from our side, we will be as transparent as possible. And that's why we have posted the TORs, that's why we have posted the list of experts. And anything forward, will be posted openly for you, journalists, and others, the public, to see there is nothing to hide. We want to know the origin. That's it. As much as you want to know the origin of the virus, we do want to know the origin of the virus because it will help us to prevent future outbreaks. Tedros Adhanom Ghebreyesus: (15:45) So, I don't want to have any confusion on that. I want you to have clarity on that. Our position is we want to know the origin, and we will do everything to know the origin. Please, you don't need to have any confusion on this. Thank you. Margarita: (16:08) Thank you, Dr. Tedros. The next question goes to Laurent from Swiss News. Laurent, please unmute yourself and ask your question. Laurent: (16:18) Thank you, Margaret. This morning, teams of researchers from the Zurich Institute of Technology disclosed a new device that would reduce the number of health workers required to change the position of a patient in ICU from back to laying face down position from five health workers required to three. So, as in many countries, the heads of ICUs have said that the problem is not necessarily the number of beds, but the number of qualified health workers at their disposal. Could that be a game changer? And do you have other examples of devices, not products, that could be critical in the fight against the pandemic? Thank you. Michael Ryan: (17:09) Thank you. And Maria may be aware, but I'm not aware of that. We do know from observations of frontline workers that proning of patients in intensive care, that is placing them on their fronts and not their backs, has proved to be a useful way of helping patients through the most difficult phase of their own response and their own survival and recovery. Michael Ryan: (17:35) And I think it's important to note that not all innovation happens in distant labs and in academic situations; a lot of innovation comes from observations by frontline workers, trying and testing through experience, seeing what works, seeing what doesn't work, and then sharing those observations with others. And I think we'd like to commend all of those frontline workers who've done so much in improving clinical pathways in general and improving the standard of care because what's really helping patients is not just specific drugs like dexamethasone. If you look at survival rates increasing over the last 6 to 12 months, a lot of that has been because, number one, we're getting patients who are likely to deteriorate into care earlier. And that means being able to monitor and predict who's likely to become sicker based on underlying conditions or their oxygen saturation or their peak flow or their ability to exchange air in their lungs. There are many observations there that have helped to prioritize patients in the clinical pathway. Obviously, being able to decide which patients will or won't benefit from ventilation or different kinds of respiratory support, the availability of high-flow medical oxygen and ensuring that people get that in time. There are so many innovations that have come. And these have come from frontline health workers and teams together, making observations as to what works in certain circumstances. So, we will commend those. Michael Ryan: (19:02) It is important though, that those observations are taken beyond that into observational studies and potentially into trials that help to determine exactly what the benefit is coming from and how to expand that benefit into the practice of others. We have living clinical guidelines. One of the things I think that's remarkable of this response is that everything is changing so quick in clinical practice, that we have a living guideline that's essentially being updated in real time with these kinds of observations. Michael Ryan: (19:34) Again, just as an example, and again, we really thank our external partners on this. The use of medical oxygen is not just about oxygen delivery at the site of the patient. It's managing the whole process of getting oxygen to the healthcare facility, managing the distribution of oxygen within that facility and using that safely. And that's required changes in practice, changes in the supply, even down to the size of tubing that's been used, whether we're using oxygen in bottles or using oxygen concentrators, and ensuring that health workers are trained to use all of that. And there's been a tremendous amount of work done to really innovate around the supply of high quality oxygen and make many countries self-sufficient in the production of medical oxygen for their own needs. Michael Ryan: (20:24) So, I would say that this kind of frontline innovation is hugely important. And, again, commending frontline workers for not only doing the brave thing and the courageous things that they do, but learning and observing what's working, and then sharing that with the broader clinical medical and nursing community. Michael Ryan: (20:44) So, Maria may wish to add, but we can only welcome initiatives like this. We will definitely look at the... if you can reduce a labor-intensive process, such as proning the patient from five to three health workers, and you can do that safely, and I add the word, "safely," then clearly that's going to be an innovation that will help in reducing the demand on already exhausted frontline workers. Maria? Maria Van Kerkhove: (21:08) Yeah. Thanks, Mike. I'm not aware of that particular study, but just to add that these innovations that we've seen in high-income settings, low-income settings are really pushing the boundaries of how we can better care for patients. And Mike described that very clearly. Maria Van Kerkhove: (21:22) But what I do want to say is while we can increase innovation and while we can increase our capacity to develop and produce supplies, we don't have that same ability to accelerate the increase in the workforce because of the training that is required for individuals to be able to care for patients. We've seen incredible efforts across the world to have students and medical students advance, come forward to be able to care for patients and help supporting in the care of patients. We've seen volunteers come forward. We've seen retirees come forward, come out of retirement. But I just want to highlight that while we can increase the innovations, and that is really advancing our ability to care for patients and to keep health workers safe, we don't have that same capacity to increase the health workforce. Maria Van Kerkhove: (22:12) And I would be remiss if I didn't add that we need, as individuals, to do everything we can to prevent ourselves from getting infected and needing to be cared for in a health facility. We cannot emphasize this enough. The burden on the healthcare facilities, on healthcare workers right now in many countries across the world is really astounding. While case numbers are declining in a number of countries, the numbers of deaths are increasing. The demands on health workers are increasing. And so, we must do everything that we can, especially as the director general has said, through the holiday season and into the new year, do what we can to protect ourselves and protect our loved ones, because health workforce right now is a finite capacity. And we just need to all play our part to try to prevent us from needing that care in the first place. Margarita: (23:04) Thank you very much, Dr. Van Kerkhove. Margarita: (23:06) So, the next question goes to John Miller of Reuters. John, could you please unmute yourself and ask your question? John Miller: (23:15) Yeah. Thank you very much for taking my question. At the outset, you talked about eliminating unnecessary travel for the upcoming holidays. There's a broad discussion going on among numerous countries in Europe and beyond about the appropriateness of holding a ski season. Some countries favor it; some countries are opposed to it. In general, skiing requires either short-distance or long-distance travel. What is the WHO's position on holding a ski season? And can it be done safely, or should countries stop skiing for the year until there is a solution to the virus? Thanks. Maria Van Kerkhove: (23:52) So, thanks for this. I can start. And maybe Mike would like to add here. In terms of all of these questions, specific to a ski season or specific to travel or specific to any activity, what WHO advises is a risk-based approach in terms of what can be done, how it can be done, if it can be postponed and if it can't be postponed, how it could be done safely. Skiing is no different. There are different countries that are looking at whether to keep it open or to close it, whether they can keep it open in a safe manner. But what WHO has outlined are ways in which people can reduce the opportunities for them to be infected. If the virus is circulating in an area and if people are in close contact in that area, the virus can spread. It's as simple as that. And so, what are the measures that need to be taken to be able to minimize that risk, minimize that opportunity for spread? Maria Van Kerkhove: (24:49) So, there are ways in which different activities can be held safely or in a more safe manner, but right now there is no zero risk. And while we are definitely seeing some improvements in case incidents in many countries across Europe, it has come at some high costs due to the stay-at-home measures and the other restrictive measures that have been put in place. We really need to remain vigilant in terms of everything that we could do to prevent that spread. Maria Van Kerkhove: (25:16) So, it needs to be a risk-based approach in looking at what policies, decision-makers need to be put in place, taking into account the circulation of the virus, the measures that could be put in place to keep people physically distant from one another, to make sure that we don't give the virus an opportunity to spread further. Michael Ryan: (25:37) Yeah, I agree with Maria. This really has to be a risk-managed approach. And the risk in this is not necessarily skiing itself. I suspect many people won't be infected while barreling down the slopes on their skis. The real issues are going to come at airports, on buses taking people to and from ski resorts, ski lifts and places where [inaudible 00:26:08] pinch points in the skiing sort of experience, where people come together in large numbers and there are pinch points in that. Not to mention the apres ski that so many people seem to enjoy is another issue. So, here you're dealing with issues of airline transport, bus transport, the opening or closing of bars. It's not just about skiing; it's a much broader issue. So, I don't think we should be reducing this down to skiing or ski season. Michael Ryan: (26:34) What every government needs to be looking at is all forms of gatherings that lead to people congregating or moving en masse, and how they're going to derisk those processes. If they don't believe those processes can be derisked enough, then curtailing, postponing or managing it in that way. And I think rather than targeting the ski season, the next thing it'll be spring season and the hiking season, and then we will be... We had the previous issue in summer and holiday. So, I think rather than targeting the actual activity, it's important for governments now to look at the risk management, end to end of this process. Michael Ryan: (27:11) So, governments who potentially don't have skiing as part of their economic activity may be sending lots of people to go skiing, who may return with the risk. So, it's not just the places in which skiing occurred; it's the risk that's exchanged between locations based on the movement of people. It's not that they went skiing or they're going skiing. That's not the issue. The issue is any activity that involves large numbers of people, moving into a concentrated space and then using public and other transport to get there and back needs to be managed carefully and it needs to be managed, as Maria said, with very much a risk-management approach. Michael Ryan: (27:51) We don't hold a position on whether something should be canceled or not canceled because the circumstances change in each and every jurisdiction. So, we would advise that all countries look at their ski season and other... Michael Ryan: (28:03) ... that all countries look at their ski season and other reasons for mass gathering, be they sports or recreation or religious, and looks very, very carefully at the end-to-end risks associated with that. We are in the middle of a deep moment of transmission. We've seen great progress made, certainly in Europe, over the last number of weeks, as the DG said, with the application of measures, however difficult, have reduced in the turning around of that. We want to maintain that progress. Michael Ryan: (28:36) As we say, there are travels that are needed. People may need to travel for all kinds of different reasons. The question is whether travel is considered to be essential or necessary, and in that, I think countries are going to have to look at mass recreation and see whether or not that can be managed within their current risk management framework. Margarita: (29:01) Thank you very much Dr. Ryan and Dr. Van Kerkhove. I think we're now move from snow to tropical regional Brazil because we have Bianca from Globo. Bianca, please, unmute yourself and ask your question. Bianca: (29:19) Hi, Margaret. Can you hear me? Margarita: (29:21) Very well, Bianca. Please, go ahead. Bianca: (29:24) Thanks a lot. Yeah, here, Bianca Rothier. I'm a correspondent in Switzerland for Globo, the largest TV network in Brazil. My question is again on Brazil. Brazil clearly sees an increasing the number of cases and deaths. My question is probably to Mike and Maria. What is your main concern with Brazil at this point in time, and technically, does [inaudible 00:29:54] see it as a second wave or is Brazil still facing the first wave? Thanks. Michael Ryan: (30:05) I think we spoke pretty extensively about this on Friday. I think, as I said then, it's not a specific concern related to Brazil. It's a general concern related to Central and South America where many countries have fought very hard to get their numbers down. The numbers have not returned to extremely low levels, so many countries are still moving along with reasonable, but they're not low numbers, and the difficulty now is, in some countries, as they begin to see a rising number of cases, they need to look at that at a national and sub-national level, so even in the case of Brazil, the disease numbers are going down in a number of states but rising in others, so I think it's about looking at the problem now and being very, very clear and very, very directed. Michael Ryan: (30:55) Where are cases jumping back? What's driving that raising cases? What can be done at that sub-national level to deal with that, very much like the first waves. Whether you call this a second wave or a surge within the first wave, we can have those pedantics all night. The fact remains that the numbers are increasing again in a number of countries, and that must be addressed, but that increase is very unlikely to be everywhere at the same time. Michael Ryan: (31:24) It's very likely, as it happened in Europe, to be occurring in specific zones, and we need to look at those zones and see whether or not we can act fast and implement measures that will be aimed at suppressing the numbers of disease so that the health system stays intact as it did before. Again, the healthcare workers of Brazil did a fantastic job during the previous peak in maintaining basic capacity of the health system to deliver across the country. That was a gargantuan task. Michael Ryan: (31:55) Again, my advice would be look at the sub-national level, look at where the increases are occurring, ensure that we have rapid action in those areas both to contain the disease and support the health system. We all know the complexities of responding to COVID, particularly in countries that have both deeply rural and very, very urbanized settings, and within those urban settings, a very different profile in the population from the very wealthy to people living in slums and who have little access to services. Michael Ryan: (32:29) It's a very diverse situation, no one-size-fits-all, but we want to avoid the health system coming under huge pressure, and we want to take action as quickly as possible in the areas where we see the disease jumping back up. That advice is not just for Brazil. That really is for any country facing a rebound in its cases. You'll see in the case of Europe how countries that reacted quickly to the new numbers seem to have done pretty well in suppressing those numbers and protecting their health system. Michael Ryan: (33:04) Now, hopefully with the continued follow-through, we would like to see that follow-through in Europe to follow through with low numbers of cases, and then begin to introduce vaccines. If we have followed through a low numbers of cases, then other health services can continue to recover. Meg is here to speak about that from the perspective of HIV. We need that. We need the system to be able to not just survive COVID, it's got to deliver other services, and it's got to recover that capacity to deliver a full service to everybody. That's, will be the same in Brazil or anywhere else. Michael Ryan: (33:39) We're not just trying to get the COVID numbers down for the sake of getting COVID numbers down. We're trying to get the COVID numbers down so the health system can get back to what it's supposed to be doing, which is preventing and treating other diseases at the same time. The advice goes for Brazil as it goes for everyone else. I don't know, Maria or Meg, if you want to add. Maria Van Kerkhove: (34:00) Very, very briefly, and then I'll pass to Meg. I think that it's the same advice for all countries, as Mike has just said. It's tailor the approach. It's look at what your data is telling you on where the virus is circulating, where the intense activity is, and tailor and target your interventions to really bring it down further, and then second, bring it down, keep it down, follow through. We've seen so many countries that have brought transmission under control, areas that have brought transmission under control, and they haven't been able to keep it low because of a number of reasons. Maria Van Kerkhove: (34:31) Bring it low, keep it low, follow through. Maintain your vigilance, maintain activities, and really jump on any cases that begin so that they don't have the opportunity to seed into something further. That is advice that is for every country and every continent of the planet right now, but really, it's important that when you've been able to bring it down, you keep it down. Meg. Dr. Meg Doherty: (34:56) Thank you very much. I think that's really quite important right now as tomorrow we're heading into celebrating World AIDS Day. This year, the theme of World AIDS Day is global solidarity, resilient services, so I think it really builds upon the conversation that you're having here and also the concern about what can we do in either a second or a third wave or cases because what we've seen in, at least HIV services, is that early on, we saw some dipping in terms of the number of people getting tested, the number of people getting put onto treatment, and that can have effects over the long-term of increased deaths, increased new infections. Dr. Meg Doherty: (35:38) But we've seen since June up until November sort of a rebound where as the cases are lower, systems have been able to regroup and put more people back onto therapy, shore up their ARV stocks, make sure that they have adequate supplies, ensure that the healthcare workers are doing multiple tests, not only taking care of COVID testing, combining COVID and HIV testing with TB testing so that essentially, really, that the healthcare workers can start to rebuild and build back better. Dr. Meg Doherty: (36:12) As we move until tomorrow, World AIDS Day, we also know that many of the infectious diseases, we've heard about malaria today, we'll hear about the reporting in HIV, we're having a bit of a plateau, and the COVID on top of that can actually increase the catch-up that we need to do as we start to have a scenario where we can have these essential services working at 100%. We're really going to be calling upon healthcare workers and countries and governments to maintain and engage and protect their healthcare workers. For HIV, that's particularly important for community-led and community-based healthcare workers as well as nurses and midwives and this year of the nurse in the midwives. Dr. Meg Doherty: (36:59) We're also, as was mentioned earlier, really looking to take all those innovations that have come out during COVID, whether it's putting more into the hands of the person, person-centered care, having therapies that can go home with them for three to six months, having self-testing, self-collection of tests and/or other medicines. More of that can be done as we move forward so that we can protect people who need to take their medicines and people who need to be coming into the clinic but they don't have to come in every single time. Dr. Meg Doherty: (37:34) Lastly, we want to ensure that the lack of disruptions and that the build back in disruptions are maintained as we move forward. I would have to say also there's going to be always, with World AIDS Day, some very exciting news. There's news around new prevention measures that are going to be available for people such as the dapivirine ring. We have seen news reports around long-acting injectable prevention, innovations around new drugs for children at very low prices so that the youngest children can have dolutegravir. We believe all of these innovations have to come together so that we can actually work towards ending AIDS as a public health threat by 2030. Dr. Meg Doherty: (38:22) I think that ties it up going back to maintaining these services, and we're hoping that with the next waves or in the spring and the summer that we won't have to see dips again where we have to work back, that we maintain the actual hard work that all the healthcare workers are doing right now to maintain the numbers. Thanks. Tedros Adhanom Ghebreyesus: (38:42) Margarita. Okay. Thank you. Thank you, Meg. Thank you, Mike and Maria. I just would like to add one thing because I want Brazil to take it seriously. As you may know, the number of cases in Brazil reached its climax on the week of July 17, which is 319,000 per week, which is a record. Then the good news was it was declining. The number of case were declining until November, the week of November 2, which is 114 cases per week. It's almost a cert of what has been reported when it reached its climax. Tedros Adhanom Ghebreyesus: (39:37) But now, on the week of November 26, it's back again to 218,000 per week. 319,000 when it reached its climax. Started to go down until it reached 114 cases per week in November 2, and back to 218,000, so from November 2 to November 26, it has, again, doubled. The death rate also, it has been declining until November 2, and now, it's increasing significantly. If you take the November 2, the week of November 2 deaths, it's 2,538, and now, we have 3, 876, meaning it's a significant increase between November 2, the week of November 2 and the week of November 16. That's from 2,538 deaths per week to 3,876 deaths per week. I think Brazil has to be very, very serious. As what Mike said, that our local transmission that's fueling and contributing more, but if you see the aggregate, it's very, very worrisome. Thank you. Michael Ryan: (41:17) Margaret, just to maybe add. I agree with Tedros' comments there, but just to make [inaudible 00:41:24] HIV and people in TB and malaria and noncommunicable diseases and the mental health program and the sexual reproductive health program in immunization in child health, and that's here and at country level and out there in the frontline, this has been a hugely demanding 11 months. It's one thing to have to respond to COVID, and the resources are there to do that on the attention is there. It's much harder, and it's been much harder for frontline workers and health workers and hospital workers to continue to deliver all of these other services when the attention and the resources and the visibility is all on the other side of the equation, and the- Michael Ryan: (42:03) And the visibility is all on the other side of the equation. And DG has said this many times, we don't get enough opportunity to thank those who've kept all of those services going and kept them ticking over, and now we're helping them to recover. Those services would not be recovering so quickly unless people had really kept that engine running right the way through the really bad times in this pandemic. So I think the world, we owe a great debt of gratitude to those individuals and teams who've been non COVID working, delivering on those services right way through. And those workers, in my view, are more heroic, because it's harder to be in hero when nobody's watching. It's harder to be a hero when nobody's listening. Michael Ryan: (42:46) So I guess, an opportunity for us to recognize the role that all of these services have played, right the way through. I know that DG speaks of this all the time, but on the events of, with a World AIDS day tomorrow, I think it's steamed to celebrate what can be done, and HIV AIDS program and others have led the way on things like equity and access and all these principles that we expound for COVID-19. I think we need to follow the path of the programs who've managed to generate equity and have access to essential services for these diseases. So, thank you. Margret: (43:24) Thank you very much. And staying on HIV, Simon [inaudible 00:43:28] would like to ask a question on HIV. Simon, could you unmute yourself and ask your question? Simon: (43:35) Yes. Thank you, Margret. Thank you for having me. This is Simon [inaudible 00:43:38] from Today News Africa in Washington, DC. South Africa continues to have the largest number of people living with HIV and AIDS, but over the past decade, the country has made significant progress. It has reduced new transmission by 60% and death by also 60%. Is there anything that South Africa is doing right? And can we learn anything from COVID-19 to tackle HIV and AIDS in the world? Thank you. Dr. Meg Doherty: (44:18) Thank you for that question. I would have to say there's a lot that South Africa has done right, and I think South Africa really has to be congratulated for much of the work that they've been doing over the last many years, because they have the largest burden of people living with HIV. And a few examples of what has gone really well is a focus on decentralization of their treatment program ensuring that it's integrated with what's considered a nurse-based approach using community healthcare workers to support the HIV program. Dr. Meg Doherty: (44:58) Over the past year you've been transitioning to using the optimal therapy, including Dolutegravir, and you've been forerunners in the work around maternal and child health, reduction of mother to child transmission through good ANC program and what we call PMTCT programs, as well as finding and treating all of your children and testing them to the best of your abilities. Dr. Meg Doherty: (45:25) And certainly another area where you're really standing out is you're starting to work on prevention. South Africa has very high risks among adolescent girls and young women, and I think this is the time now where South Africa, who has been taking pre-exposure prophylaxis very seriously, to really expand that and make sure that young women, young men have access to good prevention services, including what we call prep, or either a pill, Dapivirine ring, or in the longterm and over the next several years, potentially injections that can protect them from becoming infected. Dr. Meg Doherty: (46:03) So I have to say on World AIDS day, South Africa gets a gold star, but there needs to be more work done and certainly greater coverage attained to be able to control and achieve the end of AIDS as a public health threat in the near future, so thank you. Margret: (46:20) Thank you very much, Dr. Doherty. The next question comes from Michael from CNN. Michael, could you unmute yourself and ask your question? Michael: (46:34) Good morning from British Columbia. Thank you for taking my question. A lot of Canadians were really jolted last week when they learned that the majority of Canadians won't be vaccinated against COVID-19 until as late as December 2021. So months after people in other G7 countries, and a big reason for this is, of course, we don't have our own domestic vaccine production.