00:00:18 MH Hello, everybody. This is Margaret Harris at WHO headquarters, Geneva, welcoming you to our global press conference on COVID-19 today, Monday November 23rd. We have with us as always in the room the WHO Director-General, Dr Tedros, Dr Mike Ryan, Executive Director of our Emergencies Programme, and Dr Maria Van Kerkhove, our Technical Lead for COVID-19. We will also be joined remotely by a number of people including some special guests whom Dr Tedros will introduce. On the line to answer your questions will be Dr Mariangela Simao, our Assistant Director-General for Access to Medicines and Health Technologies, Dr Bruce Aylward, Senior Advisor to the Director-General, who leads on the ACT Accelerator, and Dr Soumya Swaminathan, our Chief Scientist. As usual we are translating this simultaneously into the six official UN languages plus Portuguese and Hindi. We will be posting the Director-General's remarks and an audio file of the press conference on the web as soon as possible and transcripts will also be available later. Now without further delay I will hand over to Dr Tedros to give us his opening remarks. Dr Tedros, you have the floor. 00:01:33 TAG Thank you. Thank you, Margareta, and welcome. I would also like to use this opportunity to thank Fadela, who has been moderating until today. Good morning, good afternoon and good evening. With the latest positive news from vaccine trials the light at the end of this long, dark tunnel is growing brighter. There is now real hope that vaccines in combination with other tried and tested public health measures will help to end the pandemic. The significance of this scientific achievement cannot be overstated. No vaccines in history have been developed as rapidly as this. The scientific community has set a new standard for vaccine development. Now the international community must set a new standard for access. The urgency with which vaccines have been developed must be matched by the same urgency to distribute them fairly. Every government rightly wants to do everything it can to protect its people but there is now a real risk that the poorest and most vulnerable people will be trampled in the stampede for vaccines. That's why in April with support from multiple partners WHO established the Access to COVID-19 Tools Accelerator. The ACT Accelerator has supported the fastest, most co-ordinated and successful global effort in history to develop vaccines, diagnostics and therapeutics. More than 50 diagnostic tests are being evaluated and new rapid antigen diagnostics are being made available for low and middle-income countries. Life-saving dexamethasone treatments are being rolled out and new medicines including monoclonal antibodies are being tested. 187 countries are now participating in the COVAX facility to collaborate on the procurement and roll-out of vaccines, ensuring the best possible prices, volumes and timing for all countries. Importantly COVAX is also analysing and supporting the systems for delivering vaccines and other COVID-19 tools which have been mapped in four regions and we're rolling out other tools like the WHO Academy's new augmented reality course for health workers on the correct use of personal protective equipment. However only a fundamental change in funding and approach will realise the full promise of the ACT Accelerator. US$4.3 billion is needed immediately to support the mass procurement and delivery of vaccines, tests and treatments. A further US$23.8 billion will be needed next year. 00:05:01 This isn't charity. It is the fastest and smartest way to end the pandemic and drive the global economic recovery. The International Monetary Fund estimates that if medical solutions can be made available faster and more widely it could lead to a cumulative increase in global income of almost US$9 trillion by the end of 2025. The real question is not whether the world can afford to share vaccines and other tools. It's whether it can afford not to. At the G20 leaders' summit on Saturday it was very encouraging to hear world leaders expressing their support for WHO and their commitment to the ACT Accelerator. Thank you. In September WHO established a facilitation council for the ACT Accelerator to leverage high-level political commitment to put the tools to defeat COVID-19 in the hands of the people who need them most. Today we're honoured to be joined by the two co-chairs of the ACT Accelerator facilitation council, His Excellency, Dag-Inge Ulstein, Minister of International Development of Norway - takk sa mye, takk skal du ha - and Dr Zweli Mkhize, Minister of Health of South Africa. 00:06:44 Minister Dag-Inge Ulstein, welcome and you have the floor. Takk skal du ha again. DIU Thank you so much and good evening, Dr Tedros. By the time I have presented my speech today many people will have received a positive COVID-19 test. Others will have been told that their loved ones did not make it. As of today there are more than 55.5 million confirmed cases, more than one million deaths. Every second matters. This pandemic is not going away if we sit still and do nothing. Moreover it is not going away if some countries are only taking a my-nation-first approach. Such vaccine nationalism is not only morally reprehensible, it is also a stupid thing to do because, as already heard many times, we are not safe until we are all safe. Our economies will continue to bleed money if countries with a large number of cases lack in obtaining the vaccine and other medicines. We are in this together and the solution is only achievable if we work as one team and, yes, time is running out. 00:08:06 This is not only a health crisis. It is an economic crisis, it is a nutrition crisis, it is a protection crisis, it is a humanitarian crisis. I could have gone on and on and on. The real-world ramifications of the pandemic are all too clear to see. Every day jobs are being lost. The ILO estimates that 495 million full-time jobs will be lost in the second half of 2020. Every day people are being pushed into extreme poverty. The World Bank estimates that this could be the case for an overwhelming 150 million people, 150. Every day children around the world are sitting at home as their schools are closed in an attempt to contain the global pandemic. This has taken 1.6 billion students out of classrooms around the globe. For millions of girls and young women, particularly those in the world's least-developed countries school shutdowns bring other risks such as domestic violence and sexual abuse. This pandemic affects us all but it does not affect us all equally. UN Chief Antonio Guterres warns that the impacts of the COVID-19 pandemic are falling disproportionately on the most vulnerable; people living in poverty, the working poor, women and children, persons with disabilities and other marginalised groups. 00:09:39 This is easy to forget as we are all faced with COVID fatigue. So now is not a time to feel sorry for movie time lost, parties not attended or dinner parties postponed. We owe the most vulnerable that we do whatever we can to end this pandemic. The human costs of not acting are obvious. So are the economic consequences. We heard some of the numbers. The IMF foresees $11 trillion will be lost in GDP in 2021. Behind these forecasts lie businesses, jobs, local communities, families and individuals. As economies bleed money futures are stolen and the occasional opportunities lost. Mental health issues are rising. The sooner we get the pandemic under control the sooner we can reopen societies and get the global economy back on track. To stop the pandemic we need to ensure that effective diagnostics, therapeutic drugs and vaccines are not only developed. To stop the pandemic we need to ensure these tools are distributed to people around the world. If we are to succeed in this we need to engage with civil society, humanitarian organisations and the private sector and, yes, there is hope. We have tests that provide results in less than 30 minutes now. 00:11:06 We have better knowledge of how to treat the disease. We have a wide portfolio of vaccine candidates on the cusp of finalising phase three trials. We need to make sure that we do not end up with having these tools but not the infrastructure to make them available to all. Fortunately there is a clear path forward and that is the Access to COVID-19 Tools Accelerator, ACT A. This initiative was set up to promote equitable global coverage of vaccines, tests and treatments and strengthen the health systems. In just six months ACT Accelerator partners have compiled the world's largest portfolio of these tools. To continue rolling out rapid testing, evaluating new treatments and ensuring access to vaccines as soon as they are licensed the ACT Accelerator urgently needs 4.3 billion and a further 23.9 billion in 2021. So we have a problem; we have a solution; now we only need to make it work. 00:12:19 I would argue that this is a no-brainer for the world leaders. $23.9 billion sounds a lot yet the total need is less than 0.1% of global GDP. In other words if G20 countries were to devote just 1% of their current stimulus spending on the efforts to alleviate the economic consequences of the pandemic globally they would actually more than cover the needs of the ACT Accelerator. I would argue that this is a small price to pay to get the world back on track. Once full travel and trade are restored that investment would be repaid in as little as 36 hours. I think we all know that the cost of inaction far outweighs the cost of action so this is the best business case ever and it is the only way. There is no plan B so each dollar, pound, euro, yuan and yen spent on the accelerator is underwriting future demands for goods and services so that global trade and growth can bounce back. In a letter sent last week from South Africa, Norway, the European Commission and WHO we called on the G20 countries to consider support to the global COVID-19 response as part of their domestic stimulus spending and to contribute substantial amounts to fully fund the ACT Accelerator. 00:13:50 As the G20 summit in Saudi Arabia closes I think we can say that we are being hurt. The 20 biggest economies vote [?] to spare no effort to supply COVID-19 drugs, tests and vaccines to all people. Yes, we still have a long way to go and the pledging marathon will continue. However I think the recent news about coronavirus vaccines and the strong support from the G20 meeting addressing the need for solidarity and multilateral co-operation makes me truly believe that we can allow optimism to fuel our next steps. Yet only a fundamental change in funding and approach will turn new hope of technological achievements into an effective weapon against the virus and allow us to change the course of the pandemic. I trust that every world leader will see that this problem is not solvable if we don't collaborate. The cost of inaction and the human consequences of prolonging this pandemic should be incentive enough. So to end, it's amazing what we have actually achieved so far. Despite many ongoing conflicts in the world, despite difficult topics all countries are somehow united in this. Yes, when it comes to the ACT Accelerator we are still sitting around the same table yet we come to the table with different perspectives and different needs. 00:15:21 But so far everyone has been willing to listen, to stretch to try to understand and meet each other because we understand how closely interwoven our countries and people actually are. The ultimate goal becomes so much more important than just launching the best and right solution for ourselves. With that said, back to you, Dr Tedros. Thank you. TAG Thank you. Thank you so much, Minister Ulstein, for your support and commitment. As you said, I fully agree; the best case ever and it has to be supported. Thank you so much again. It's now my great honour to introduce Dr Zweli Mkhize, Minister of Health of South Africa. Your Excellency, welcome and you have the floor. Thank you so much for your support also. Thank you. ZM Thank you very much, Dr Tedros, the Director-General of the WHO and all the members of the WHO team, my colleague, the Co-Chairperson, Minister Dag-Inge Ulstein. Thank you very much for the opportunity to be part of this very special occasion, this briefing. If there was ever a case for solidarity and global co-operation this COVID pandemic has demonstrated why. 00:16:48 The crisis is hitting the world hard and our most fragile regions harder, affecting income, health, education and other parts of our socio-economic lives. COVID-19 does not respect national boundaries and as long as it exists anywhere it is a threat everywhere. No-one is safe until everyone is safe. Global solidarity isn't just the right thing to do; it's the smartest thing to do. Ensuring that tools are allocated equitably, not based on income but based on universal protection against COVID-19 is the fastest and most effective way to defeat the pandemic and get our lives and our economies back to normal again. We must treat Access to COVID-19 Tools as a global public health initiative. Collective efforts to stamp out the virus now would also mean that future deadlier strains or mutations that are more difficult to treat could be avoided. It is clear that every country will need to play a part in financing an end to this crisis and every leader has a political choice to make. 00:18:04 But the lack of adequate financing for our global exit strategy, the ACT Accelerator, is an existential threat to the economic and health security of all countries and their citizens. Speaking from the perspective of the African continent it has now recorded over two million cases with 49,000 deaths, which accounts for 2.5% of the global caseload. There are signs of resurgence in 18 countries which is 38%. More than 20% increase is recorded in the numbers in the last seven days when compared to the previous seven days. It's also not certain how a resurgence on the African continent will evolve and therefore any equal access to vaccines and therapeutics will be critically mitigating the threat posed by the resurgence on the continent. As part of these preparations President Ramaphosa, His Excellency, Chair of the African Union established a COVID-19 African vaccine acquisition task team to lead this effort. In addition to equitable access to COVID-19 tools we also need to pay attention to the strengthening of health systems. The ACT Accelerator offers a clear way forward for ending the crisis through global co-operation that will deliver. All countries need to end the acute phase of the pandemic, restoring economic vitality and averting catastrophe. 00:19:43 Whilst the pace of scientific research and development into effective vaccine therapeutics and diagnostics is unprecedented its true value will only be realised if countries can access these tools and are prepared for their use. Every country has work to do to ensure that once ready these tools can be rapidly deployed. This includes ensuring that capacities and infrastructure that need to be rapidly scaled or upgraded to deploy COVID-19 tools are ready and working. Bottlenecks in key areas of health systems such as data, workforce, clinical care, supply chains as well as access to key commodities such as PPEs and oxygen remain limiting factors to effective deployment and use of COVID-19 tools in many countries. The health system connect, a pillar of the ACT Accelerator, is a critical mechanism to support countries to bolster and strengthen through a tailored approach that uses global knowledge to address local problems. 00:20:50 Countries' readiness is an absolute prerequisite to the equitable scale-up of the COVID-19 tools. It is a hurdle we must clear if we are to win this race and this is one time when we all need each other and every country matters and therefore we need to make sure that we focus on more and more partnership, solidarity and global co-operation. Thank you very much, Dr Tedros, for inviting us. Thank you. TAG Thank you. Thank you very much, Minister Mkhize, for your support and commitment and I look forward to working with both of you in this very critical period to realise the promise of the ACT Accelerator. Thank you so much again and I hope you will stay with us for a few more minutes to answer questions from the media if we have them. With that, back to you, Margaret. MH Thank you very much, Dr Tedros. Yes, we will now open the floor for questions. I probably don't need to remind you you need to use the raise your hand icon to get in the queue. We already have a large number of you in the queue so I ask that you restrict yourselves to one question. Remember we also have our experts on the line and in the room so indicate clearly what your question is. 00:22:22 We have limited time so please keep your questions short. I will stop talking now and give you a chance to ask your question. The first one goes to Corinne from Bloomberg. Corinne, could you unmute yourself and please ask your question. CO Hi, thanks for taking my question. It'd be great to get your take on the AstraZeneca vaccine results, especially since it said that they're going to try to get a quick recommendation from the WHO and it seems the results are not that straightforward. MH That question, I think, will go to Dr Soumya Swaminathan. Dr Soumya, are you on the line? SS Yes, I am, Margaret. Thank you for that question. First of all I'm sure the person who asked the question, like all of us, is very encouraged by the news that we got today with the preliminary results that have been released from the clinical trial of the AstraZeneca vaccine, following on from the encouraging results from the two earlier vaccine, the Pfizer and the Moderna, both of which are MRNA vaccines, the AstraZeneca vaccine being a viral vector vaccine. 00:23:42 So I think the good news is that vaccines for COVID-19 are possible to make and it's possible that we will have a number of different vaccine candidates that can be used in the fight against this disease. As we're discussing the ACT Accelerator today I think this I very relevant because we would like to provide access to as many efficacious and safe vaccines as possible so we can cover the population around the world. Remember we have to cover a huge number of people, billions and billions of people. This is unprecedented and we will need all the manufacturing capacity in the world to be able to do that. On the AstraZeneca results themselves we've heard only the preliminary results about the vaccine trials that were done in the UK and Brazil looking at two slightly different dosing schedules. The schedule that had the same dose given two times had a slightly lower efficacy but still it was about 62%, which is above the benchmark that we had set but the schedule which gave a smaller dose followed by a larger dose; the efficacy seems to have been higher, up to 90%. 00:25:01 But again this is based on rather small numbers and I think we need to wait to see the results both of the efficacy and the safety. The AstraZeneca vaccine is also being currently trialled in many other countries and eventually we should have data in about 60,000 patients or so. That will enable us to take a much more informed decision. So we await discussions with the company and they're already talking with our pre-qualification programme on how they will go about it and Dr Simao's available to answer more questions on that. Thanks. MH Thank you, Dr Swaminathan. Over to Dr Simao for some added points. MS Thank you very much, Margaret, and thank you, Corinne, for the question. Actually we have already had several discussions with AstraZeneca following the expression of interest WHO issued for the emergency use listing and pre-qualification of the vaccines so we are very hopeful and we are about to receive more clinical data in the next week. 00:26:13 We are also aware that AstraZeneca is also submitting the dossiers to the European Medicines Agency and we do have very close collaboration. There are actually eight sites; some of them are manufacturing sites so we will be analysing this data very carefully but very much welcome the results so far. We expect that we should finalise the assessment in the beginning of next year. Thank you. SS If I could just add, Margaret; I forgot to mention the advantage of this vaccine is that it can be stored at ordinary refrigerator temperatures of two to eight degrees and is stable at that temperature. That of course has huge logistical advantages for transporting and delivering this vaccine to cities, towns, villages and rural areas around the world. We hope there will be more vaccines like that which are more heat-stable and we have to also continue to encourage all the other developers who are doing clinical trials and who are in early phases of development because we do need a variety of vaccines out there that will target different groups better, that will have different storage conditions. Also the issue of affordability is important to keep in mind. Thanks. MH Thank you, Dr Swaminathan and Dr Simao. There do not seem to be any comments in the room so I will take the next question from Gunila, the Geneva correspondent for Swedish media. Gunila, please unmute yourself and go ahead. 00:28:05 GU Can you hear me? MH Yes. Please go ahead. GU Thanks for taking my question. It is very promising that a vaccine candidate is coming but first we have Christmas and Christmas is now about one month away. Countries have started to give advice; in the UK they said we can have an exception of three households celebrating Christmas together, which could be a lot of people. In Sweden meanwhile the Prime Minister yesterday said there should be one family staying inside for the time being. I'm wondering, would you be able to give advice, recommendations for how countries should deal with celebrations around Christmas, especially in Europe, which now still have a very high community transmission? 00:28:57 MR I can start. Maria will follow up. I think first of all it's important that we separate the science of COVID-19 from what are the policies that surround that science because governments have to make choices and they have to decide on the local epidemiology of the disease, they have to decide what the tolerance level of the population has been, how long people have been in lock-down or not in lock-down, what level of control they have, how strong their public health architecture has become over the last number of weeks, have they expanded their capacity to test, trace, quarantine and isolate those people who are actually sick or carrying the virus. are they able to protect vulnerable populations. So the decisions to ease restrictions coming towards a holiday period - and there are many countries heading towards holiday periods; we've seen the most recent holiday period in Canada, their Thanksgiving; they did see an increase in transmission after that period because people come together, they mix, they travel. It's inevitable that in the presence of community transmission if you further release the opportunity for the virus it will find opportunities to transmit. But there is the trade-off, the economic and social trade-off in that so I think it's really important that we're not trying to bend science in this. The science is straightforward. If there is significant community transmission in your country and you don't have the necessary public health architecture to track and trace and isolate and quarantine contacts then further opening up will result in increased transmission. 00:30:39 There's no question of that. The question is, have you got the disease under enough control to start with and can you in a sense allow people a little bit more freedom over the Christmas period, which generates a sense of confidence and a sense of joy in the community, which people need right now, without letting the virus let rip again within our communities? This is a very important trade-off and it's a trade-off between those two issues. The science is clear. The policy is what's not clear and each government will have to decide on its policy based on those trade-offs between the epidemiologic risk versus and economic and social risk of continuing to have people in a restricted situation over a holiday period, which will generate genuinely a lot of frustration, further fatigue and a lot of push-back. 00:31:34 Maria may comment on the technical aspects of this but I certainly hope that we're not going to enter into a period where we're trying to come up with a formula which says, this is how much you can open up and this is how many days of Christmas we have by some scientific formula that says, this is safe and this is not safe. There is no safe or unsafe decision. There is only higher and lower risk of the situation getting better or worse depending on what you do. MK Thanks, Mike. Yes, I think the point is that there's no zero risk here right now. We are in the middle of a pandemic and many countries unfortunately are in a very difficult situation with increasing case numbers, with hospitals full and with ICUs full. As Mike has said, there's lower risk or higher risk but there is risk. This virus needs us, it needs people to spread between and if we allow it to we could be that individual that brings that virus into someone's home. What we have outlined to support countries in making those policies is a risk-based approach in terms of what is the situation in the areas where you live, where people need to travel from, where they need to travel to. 00:32:46 You as individuals need to take decisions about, how will I celebrate these holidays that are coming up, that have happened, am I going to be visiting a family that has vulnerable individuals that live in that family and what is the possibility that I could potentially bring that virus into that home where someone who lives there has a higher risk of developing severe disease and a higher risk of dying. So there are a lot of things that we outlined; who will you be visiting, what will that situation look like, can you have that holiday indoors or outdoors, how crowded will it be? There are ways in which you can reduce the risk but there is no zero risk unfortunately in this situation. I do think I agree with Mike and all of you who understand that this is incredibly difficult because especially during holidays, especially during birthdays, especially during these family celebrations we really want to be with family. 00:33:43 But in some situations the difficult decision not to have that family gathering is the safest bet so everyone will need to take that decision based on your current situation, based on your family, based on where you need to travel. We hope everyone will have happy holidays and find ways to connect. Fortunately many people around the world have access to the ability to connect virtually and I think that that may be the way that many areas need to go. But I do want to say that even if you can't celebrate together this year you can find ways to celebrate when this is all over. We are doing that within our own family. We are going to have one heck of a celebration when this is all over regardless of when that is and that is something that helps personally myself and my family get through because we know that eventually we'll be able to celebrate with our loved ones. MH Thank you very much, Dr Van Kerkhove. The next question goes to Nina Larson of AFP. Nina, could you unmute yourself and please go ahead. NI Hi, can you hear me? MH Yes, Nina. Please go ahead. 00:34:56 NI Thank you for taking my question. I understand that you've held a briefing for diplomats on the progress on the independent international investigation into the origins of COVID-19 and that some concerns were raised about the lack of transparency in negotiating the terms of reference for the mission and also over the amount of time it's taking to send a team to China. I was hoping you could provide us with more information on the terms of the agreement with Beijing and also say when you expect them to go to China. It would be good to know who's on the list or how many people are on the list. Thank you. MK Thanks for the question. I can start and maybe Mike would like to supplement. We have actually released the terms of reference for the mission online. We have also released the names of those who are on the international mission online and so that is completely transparent for you to see. As you know, we sent a pre-team of WHO staff to China over the summer to discuss with counterparts the nature in which the studies needed to take place. We've outlined phase-one and phase-two studies. It's all in the terms of reference and you can see that; where those initial phase-one studies need to take place in Wuhan, looking at the earliest cases that were reported and identified in Wuhan, looking at the epidemiologic studies that were done. There're a number of studies that are underway that need to be conducted by Chinese counterparts. 00:36:30 The international team has met and is meeting with Chinese counterparts to see how that could be supported through global collaborations. This is very technical and very science-oriented and very research-oriented because there are many, many studies that need to be undertaken. The international team will travel to China. That is being discussed amongst the international team and the Chinese counterparts and that will be arranged in due time. MR Just to add, certainly with regard to the mission briefings - and remember, we have weekly briefings with our member states at mission briefings and are engaged in very open and transparent dialogue with our member states every single week and we discuss every issue from vaccines to the ACT Accelerator last week, to the animal/human origin studies all the way through to surveillance, to contact tracing. 00:37:33 We have the member states presenting on their own case studies, on their own experience. We exchange that information and the DG has led from the front in engaging directly with our member states on a weekly basis on all matters of importance. On the issues of the progress with the animal studies in fact quite the opposite; the member states who spoke - and there were many - all expressed appreciation for the progress that was being made, for the terms of reference and asked obviously for further progress to be made in the phase one and two. We explained to our member states the content of the phase-one studies and the hopes for phase-two. One member state did express some concerns regarding the phase-one studies and ensuring that they were completed as quickly as possible. We reassured that member state that that would happen and again we did release to the member states the names of the international team members. 00:38:33 Again the international team has been brought together. We were in the process of finalising the legal documentation to be members of this group and as soon as we have been able to confirm all of that we will put the names of the team up on the list. I must also express, the international team themselves have expressed their own concerns. There has been a level of attack and abuse to people involved in international science. It is not an easy space to be in right now; let me be plain about that. We have all received our fair share of hate mail and threats and everything else right through this process and it is important that we as an organisation protect the space of science and protect those scientists. We would like to thank them for their openness and transparency and for allowing us to release their names. That's not an easy choice when you're trying to do your best for your own system and for the international system so we thank them not only for their scientific leadership but for their courage in doing that and it's a strange thing to have to say in this world today that it takes courage to be a scientist. I used to think it only took brains but now you need to be brave and courageous as well to do science in the face of the anti-science movements that we see and the ideologic politics that has come into this process. 00:39:54 We're very, very pleased with the reaction of our member states. We're particularly encouraged by the way in which so many countries are supporting everything that we're trying to do. Imperfectly as we do it, our member states recognise the massive effort that this secretariat is making with our collaborating centres and scientific partners to fight this pandemic. We look forward to making progress on the animal/human origin studies and again I made it very clear at that briefing that we are pushing for co-operation from all countries and especially from our colleagues in China who have identified a very strong Chinese scientific team and we're working very closely with that. We expect openness and transparency from all our member states when it comes to scientific collaboration and we trust we will continue to receive that from our scientific colleagues in China. 00:40:49 MH Thank you very much, Dr Ryan and Dr Van Kerkhove. The next question will go to Michael from CNN. Michael, please unmute yourself and go ahead. MI Thank you for taking my question. Can you hear me? MH Yes. Please go ahead. MI As a follow-up to the last question, it's hard to believe but we're almost at a year from when case zero or the index case for coronavirus was identified. However all we seem to know according to state documents reported on by the South China Morning Post is that it was a 55-year-old male but he can't be identified or no-one can trace him. How important is it in your investigation to find the origins of the coronavirus who case zero or the index case was? Just quickly also the wet market where the virus is believed to have originated; that's been cleaned up and closed off. How will that be an impediment to your investigation? Thank you. MR We could end up in a lot of detail. Your questions are well asked. Identifying case zero is a very important aspect of all epidemic investigations. There may be more than one case zero in some situations because there may be more than one species breach. 00:42:15 We're increasingly seeing that SARS-CoV-like viruses have been identified in many different countries; in fact in horseshoe bats most recently in the last few days. We've seen other potential intermediate hosts identified in various settings so there's no question that this virus has an actual home, probably somewhere in the bat community; some intermediate hosts who we haven't fully identified yet. How that disease then breached that barrier into the human species may have been a single event, it may have been multiple events. Those events may have occurred in one particular time or over a range of different times because if the virus is present in the animal kingdom or in wild animals then the chances of multiple introductions - and we've seen that; for example if you look at the recent human-to-mink and mink-to-human. We've seen multiple reintroductions into the human population from the mink population; it wasn't just one exposure back. The natural history of these things is at least one case zero, probably more. 00:43:19 The DG has always said and was very, very strong on this from the very beginning; we need to start where we found the first cases and that is in Wuhan in China and then we need to follow the evidence after that wherever that leads. With regard to the Wuhan seafood market, in fact one of the interesting findings is while there was most certainly a temporal and geographic cluster associated with the market not all of the cases in that initial cluster can be linked directly to the market. So the market is likely to have been a point of amplification. As we've seen for example in the event in Shanghai [?], we had a similar event. We don't know whether it was a human that drove the amplification event at the Wuhan market; was it animal; was it environmental contamination; we don't know that. But certainly it's clear that there were cases that preceded that event at the Wuhan market so the real question is, the original species barrier breach; where did that occur? That is still unknown and it is extremely important and the terms of reference for the investigation clearly lay out in phase one the necessary epidemiologic and clinical and serologic and retrospective studies that need to be done to establish whether or not there's any evidence trail that will lead back. 00:44:43 It is remarkably difficult. It is like looking for a needle in a haystack sometimes for an individual event, to look for that single event. I've been doing that in Ebola for the last 25 years and we've never hit the mark except on one occasion where we could actually identify the actual event where the disease crossed the species barrier. So this is not easy to achieve. We will pursue those investigations over the next couple of months in phase one and hopefully move on to phase two. I think, Maria, there was a second part if you want to come in, on the markets. I think it's important. MK Yes, as Mike has said, there are a lot of studies that need to be underway to find the initial case wherever they may be and look at the conditions in which they were infected so this case zero that you mentioned may not be in fact case zero. There could have been other cases that existed that weren't detected because they weren't picked up through a current surveillance system. 00:45:45 That's not a criticism; that's just a possible fact, that we need to look back, we need to look retrospectively to see what happened. The amplification event at the market in Wuhan certainly is what triggered more transmission and the conditions by which that happened are the focus of some study as well, looking at the animals that were there, that were sourced at that market, where those animals came from, where those animals were sold onward, looking at environmental samples that were collected there. There were a number of environmental samples that were collected in that initial market from animals but also from surfaces around different parts of the market and those results the Chinese colleagues have presented to the international team so there are some results from there. But all of these are clues, if you will, that help lead to the next question. As far as any answers that we get from any studies, they lead to a number of additional studies so as Mike has just said and as the DG has outlined, we follow the science. We're also working with a large number of people across the world looking at retrospective analyses in different countries. 00:46:56 You've heard of studies of waste water, studies that have looked at samples from 2019. We're working with our seroepi networks on looking at stored clinical samples and sera from 2019 to see if any of those test positive but all of these really help us to piece together how this unfolded. Just to point out, for MERS coronavirus it took us almost a year to find the intermediate host for the MERS coronavirus which is the dromedary camel, the one-humped camels. Those came from detailed epidemiologic investigations at the animal/human interface with people who were caring for camels, testing the animals, testing the camels, looking at sequences and being able to match and see that there was transmission that had happened between the humans and the camels. It does take time and we know everyone is really anxious to get these answers and those studies are underway. We need the science to unfold, we need those studies to be done carefully and thoughtfully and thoroughly and we will be there across the world with our international partners to support that every step of the way. 00:48:03 MR Can I just add to be clear again on the journalist's question, we fully expect that we will have a team on the ground. We need to be able to have the international team join our Chinese colleagues and go onto the ground and look at the results and the outcomes of those phase-one studies and verify these data on the ground. This is extremely important and we are continuing to expect that that be the case and we would like to have that team deployed as soon as possible. So we're building the relationship between the Chinese counterparts and the international team. We have regular Zoom calls between the two groups and we fully expect and have reassurances from our Chinese Government colleagues that the trip to the field part of the mission will be facilitated and as soon as possible in order that the international community can be reassured of the quality of the science. Again the Chinese colleagues have done a tremendous amount of scientific investigation and in fact, I think, have published hundreds and hundreds of papers regarding the situation in China and the learnings they have done. 00:49:10 But clearly we all need to understand the origin of the virus, we all need to understand where it has come from, not least to understand where it may re-emerge in the future and I believe our Chinese colleagues are just as anxious to find those answers as we are. MH Thank you very much, Dr Ryan and Dr Van Kerkhove. The next question goes to Emilio Divinito from El Pais. Emilio, please unmute yourself and ask your question. EM Hello. Good afternoon. I'm going to make it a very short question but is it true? We've heard Dr Tedros and Mr Ulstein talking about how important it is to make sure that the poor countries are going to receive their share of the new developments; I'm thinking about the vaccines. I want to ask them how realistic it is to think that they are going to receive them on time or are they going to be the last ones in the queue. I'm thinking now that we know the plans for Spain or in Germany and in other countries, the plans that they have to vaccinate their own people where they have to prioritise amongst the populations. 00:50:32 So I don't know if it's realistic to think that these countries are going to give part of the vaccines... so how are you going to do it, make sure that the poor ones are going to receive their share? Thank you. MH Thank you. Our Minsters, our guests would like to respond to that question. DIU Thank you so much. Thank you for that question. I think this is the most important thing because it's not enough to develop vaccines. It's all about the last lap and that is why my colleague from South Africa and I have been so clear on our mission also. It's about creating equitable access for all and to make sure that vulnerable groups and critical health workers in all countries... I know that it's very much in Dr Tedros' heart and mind also because we really need to make sure that the logistics, that the infrastructure that we have, shared knowledge and trained enough healthcare workers in all countries to make sure that it's possible actually to roll out and to use those tests and to make sure that the medicine will be available and that we make sure that the infrastructure for the vaccines is in place. 00:51:58 So it will not be easy, it will be really, really difficult and that's why I am so clear that we need to first make sure that the finance gap, not only the urgent gap of 2020 but we make sure that we mobilise as much money as possible also for the gap in 2021 right now because this will not be easy, it will be really, really difficult. So we need to make sure that we use the momentum and that will not be easy but we will do whatever it takes to make sure that we will have fair and equitable access to all. That's why we also wrote the letter to G20 countries and I really hope we will have some substantial answers with new, fresh money also into the portfolio. But over to my colleague. ZM Thank you very much, Minister. I think we all agree that the approach has to be that of equitable access and the issue has to be that there should be no-one left behind in each country that requires to be assisted does get assisted. On that basis we believe that some of the discussions on the COVAX facility will take us to a point where there is a way of being able to assist those who can't fund themselves to get the basic [inaudible] to start and then the support, to be assisted as well. 00:53:29 So the general message that we're all sending across basically says that we need to focus on the... Everyone needs to be safe on the basis of having some access to a vaccine. Then of course the more vulnerable would need to be targeted first so that with time as the volumes start to increase we're able to reach out to members of society right across. But it would be quite risky to have one side covered because they can afford it and then some other member states not covered simply because they cannot afford it. That still creates a risk of a resurgence of the pandemic. So our approach is more or less the same. TAG Yes, I think the Ministers have said it very well. Maybe to stress, I think there are three important issues here. One is the political commitment to share and second is the financing. Third is preparing the infrastructure of countries. On the political commitment and financing, as the Ministers said, we have brought it to the attention of the G20 and hopefully others outside the G20 will also give their political support and also, we hope, will give their financial support. 00:55:09 It won't be easy, it's going to be tough but at the same time we have now the facilitation council and the facilitation council is chaired by Norway and South Africa. Its objective is to make sure that the political commitment and also the financing is ensured. On the third, preparing infrastructure, the World Bank, UNICEF, WHO, Global Fund have already sent a letter to our country offices to work with countries to prepare the infrastructure for vaccination, to identify gaps and fix and prepare it. That will include training of health workers and so on. All agencies relevant for this are also working on preparing the countries and that's very important, the preparation of countries. One country which we have seen really very advanced is Ecuador in terms of preparing for vaccination. I had the opportunity to speak to the Health Minister and the Foreign Minister last week and they have a very good model. 00:56:30 I think identifying best practices of countries and sharing it with countries to use will be very important. Thank you. MH Thank you so much, Dr Tedros and Honourable Ministers. We're really coming up to the hour but we're going to take one last question from Morocco and that is from Abdullah Hussan from Morocco News. Abdullah, could you unmute yourself and go ahead. I think you may be asking in Arabic. TR Yes, I have a question. Those vaccines that have been readied, that are being prepared; are they effective? Will they be provided to African countries, especially those which come from Pfizer and Sanofi? Thank you very much. MR I think the question is about vaccines. Alaikum-salaam to you. I think Soumya can come in. You asked the question whether the vaccines are effective. I think three of the vaccines have clearly demonstrated efficacy in the trials so far. That data is being put forward to various regulatory authorities over this week and next week and probably in the coming weeks and certainly that data, we hope, will also be provided directly to WHO so WHO can make decisions about emergency use listings and other things. 00:58:28 The question you have regarding providing of vaccine to Africa; I think that is really what the COVAX initiative is about; ensuring that an initiative covers 80% of the world's population and the vast majority of the population of Africa. I don't know if Bruce is online but if he is he can speak to just how many countries in Africa are actually signed up to the COVAX initiative which actually, I think, covers the vast majority of countries on the continent. Bruce. MH Dr Aylward, go ahead. BA Hi, Mike, and greetings, all. I think it's been covered already. The majority of countries on the African continent are signed up to the COVAX facility. It's actually over 45 countries now on the African continent that have actually joined and the remainder are still considering. There're issues, fiduciary and others, that need to be considered but clearly people see this as the key, as Minister Ulstein and Minister Mkhize said; the COVAX facility is key to the equitable allocation of vaccine globally and to ensuring that all countries get some product rather than some countries all product. This is absolutely crucial to getting the world out of the economic/societal health crisis that it's in today. 00:59:51 To the specific question that was asked, yes, it is absolutely possible to see an equitable allocation. This is a function, as Minister Ulstein and Minister Mkhize said, of political choices with respect to financing and to the timing and use of products. But increasingly there's very, very clear recognition globally that this is the best possible way out of this crisis. MS Can I complement? Just to say, as we heard before when the question came about AstraZeneca, it's very important that we have different vaccines and different platforms being developed because some of them, like the Pfizer vaccine, need an ultra-cold chain which brings logistic problems. There are not only challenges for countries in Africa; there are challenges for all low and middle-income countries and some of the high-income countries as well. So we see the portfolio including the other vaccines beyond the MRNA vaccines like Pfizer and Moderna as a very good point ahead in ensuring that there will be access to alternatives as the platforms are easier to use at country level. That's, in a nutshell, how we are seeing it. 01:01:19 It's very important to ensure equitable access but we need to take into account also the characteristics of each vaccine and the [unclear] environment that will make the availability at country level more challenging. Thank you. MH Thank you, Dr Simao. I'd like to ask the Minister for Health from South Africa, Dr Mkhize, if he would like to add something. ZM Yes, thank you very much. I think, following on the response that has been given, just to bring to the attention of the person that asked the question that from the African Union's perspective there's been a task team that's been set to help to co-ordinate the access to vaccine together with the member states, also working together with the COVAX facility, GAVI and the other partners. In this process the African Centre for Disease Control is the one that's at the centre, co-ordinating, looking at the numbers, the needs and so on so that in addition to whatever the WHO and all the other players are doing there is adequate support from the African Union member states. 01:02:42 This is building on the work that was done during the difficult days of the early COVID pandemic where the assistance, the support, the donations, the needs, the new tools for acquisition had to be co-ordinated through the Africa CDC. So they have actually engaged a number of manufacturers and they've engaged COVAX just to be able to understand so that everything is aligned. I think the key issue is also to say, we need to look beyond the point of the public's process in terms of what else needs to be done to reach out to the largest numbers of people who still need to be assisted. So there's quite a bit of work that's being done at that level and certainly we don't believe that the African continent, the member states will actually be left behind so there is lots of work being done at that level. Thank you very much. MH Thank you so much, Minister, and thank you very much to all journalists who joined. Your questions were excellent today. We really appreciate it. We have to finish here now but I'll hand over to Dr Tedros for a few more words. 01:03:54 TAG Yes, thank you. I think they always ask excellent questions. This Wednesday marks the International Day for the Elimination of Violence Against Women. Around the world nearly one in three women have experienced physical or sexual violence, mostly by intimate partners. As countries have implemented stay-at-home orders and other measures to prevent transmission of COVID-19 reports from women experiencing violence at home have increased. At the same time services for survivors have been disrupted. Violence against women is never acceptable. We're calling on governments to include services for women affected by violence in every country's package of essential health services and to allocate the resources to make them accessible. We're calling on health providers to pay more attention to identifying women who experience violence and provide first-line support and we're calling on everyone to show their solidarity with women affected by violence by raising their voices and by wearing something Orange this Wednesday - the day after tomorrow - as a symbol of solidarity and hope. Thank you and see you on Friday. I would like again to thank Minister Mkhize and Minister Ulstein for joining today and also for your leadership of the facilitation council of the ACT Accelerator. Thank you, Norway. Thank you, South Africa. 01:05:42