00:00:20 MH Hello, everybody. This is Margaret Harris in WHO headquarters, Geneva welcoming you to our global press conference on COVID-19 today, Friday November 27th. We have with us in the room our WHO Director-General, Dr Tedros. We also have Dr Mike Ryan, Executive Director of our Emergencies Programme, Dr Maria Van Kerkhove, Technical Lead for COVID-19, and also Dr Hanan Balkhy, our Assistant Director General for Antimicrobial Resistance, and Dr Peter Ben Embarek, a scientist specialising in zoonosis and food safety, and we also have next to me here Dr Kate O'Brien, our Director of Immunisation, Vaccines and Biologicals. They will all be here to answer your questions so please think about your questions now and get them ready. As usual we are translating this simultaneously into the six official languages plus Portuguese and Hindi and we'll be posting the Director-General's remarks and an audio file of the press conference on the web as soon as possible. Transcripts will 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. 00:01:46 TAG Thank you, Margaret. Good morning, good afternoon and good evening. COVID-19 is an uneven pandemic. All countries have been affected but not all countries have been affected equally. 70% of cases and deaths are in just four countries and there are many countries all over the world that have shown COVID-19 can be controlled with existing tools. One of the things all these countries have in common is an emphasis on testing. Since the beginning of the pandemic WHO has emphasised the importance of testing and provided the tools for countries to do it. On 13th January in collaboration with the experts we work with we published the first instructions for producing tests, just two weeks after the first cases were reported. Since then we have shipped millions of tests and other diagnostic products all over the world and we have also worked with countries to increase testing capacity. For example at the start of the pandemic just two African countries had lab testing capacity for COVID-19. By the end of February 32 countries in Africa had testing capacity and now all countries can test for COVID-19. 00:03:17 But we continue to need more and better tests that are easy to use, cheap, reliable and fast so patients can be cared for and contacts can be traced. In September WHO published our target product profiles for diagnostics, which outline the features needed for new tests. Many manufacturers around the world have been working to develop these tests. Through the diagnostics pillar of the Access to COVID-19 Tools Accelerator WHO, FIND, the Global Fund and other partners are working together to evaluate more than 50 diagnostics including self-administered tests. Once these tests are validated and approved they can be incorporated into national strategies. In September WHO issued the first emergency use listing for an antigen-based rapid diagnostic test which can return a result in just 15 minutes, along with guidance on where best to use these rapid tests. Together with our partners we also announced an agreement to purchase 120 million of these tests for 68 low and middle-income countries in all regions of the world. We're now shipping these tests around the world. Last week WHO and FIND also launched a comprehensive training package for health workers on the use of rapid antigen tests. But nearly two months later we still face a funding gap of US$500 million to maximise the use of rapid tests. 00:05:14 As vaccines are rolled out testing will continue to play a vital role. Initially health workers, older people and other at-risk groups will be prioritised for vaccination. That will still leave the virus with a lot of room to move and testing will remain a vital tool for controlling the pandemic. If you don't know where the virus is you can't stop it. If you don't know who has the virus you can't isolate them, care for them or trace their contacts but testing must be strategic, in support of clear public health objectives. Everyone who needs a test should get a test. WHO's guidance outlines how countries can test strategically based on their transmission scenario. It's also important to remember that although testing is vital it's only part of the strategy. Testing is the spotlight that shows where the virus is. Investments in testing must be matched by investments in isolation facilities, clinical care, protecting health workers, contact tracing, cluster investigation and supported quarantine. 00:06:39 WHO is continuing to support countries in different transmission scenarios to use testing strategically to bring outbreaks under control. Finally this week WHO published new guidelines on physical activity and sedentary behaviour. Physically activity is essential for physical and mental health throughout life but one in four adults and four in five adolescents don't get enough physical activity. The new guidelines recommend between 150 and 300 minutes of moderate to vigorous activity per week for all adults and an average of 60 minutes per day for children and adolescents. COVID-19 has resulted in restrictions of many types but everyone can remain active whether that's doing a work-out at home or going out for a walk, a run or a ride. It's one way all of us can add years to life and life to years. Every move counts. I thank you. MH Thank you very much, Dr Tedros. I will now open the floor to questions. I should let you know that I omitted to mention that we also have joining us remotely 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 so once again remember you have a wealth of expertise here to answer your questions. 00:08:30 It will be an hour so if I do not get to everybody I apologise in advance. We will start the questions with Simon Ateba from Today News Africa. Simon, please unmute yourself and go ahead. SI Thank you, Margaret, for taking my question. This is Simon Ateba from Today News Africa in Washington DC. Pfizer has applied for emergency use of its COVID-19 vaccine from the FDA here in the USA and is likely to be approved soon but the Pfizer vaccine has to be kept at -70 degrees Celsius and needs special storage requirements not found in many hospitals even here in the USA. With Africa having other problems such as lack of constant electricity in many hospitals what needs to be done between now and then for the Pfizer vaccine to be shipped to African countries or is it even realistic to distribute that vaccine in countries such as Nigeria where there's never been constant electricity in the past 50 years? Thank you. 00:09:48 MH Thank you, Simon. Dr Kate O'Brien will answer first and maybe others will join. KOB Thanks for that question. The Pfizer vaccine, as you indicated, does require what we refer to as an ultra-cold chain so very cold temperatures and we do have one other vaccine that has required that degree of very cold temperature and that's the Merck Ebola vaccine so we do have experience in a number of countries, specifically in Africa, being able to deploy a vaccine with that ultra-cold chain requirement. It has not been deployed across every country in the world of course so as we anticipate the use of the Pfizer vaccine the intention is certainly to be able to use it along with other vaccines because no one vaccine is going to have adequate supply nor will any one vaccine necessarily have suitable operational characteristics to meet all of the needs. But specifically on the Pfizer vaccine, Pfizer has developed a special shipper for the vaccines and even without the use of in-country ultra-cold chain freezers that shipper can actually maintain the temperature of the vaccine for a substantial number of days, in the range of ten to 15 depending on how often you open the box. 00:11:14 Furthermore the Pfizer vaccine can be maintained at refrigerated temperatures for five days prior to the final use of the vaccine. In addition to that we do have technology that can help with the delivery of ultra-cold chain. There are portable freezers referred to as Arctech [?] and other products that don't require electricity and that can maintain the temperature of the vaccine at this -70 degrees for a period of days. Finally with the use of dry ice there are ways that we can maintain vaccines at this low temperature but you do make a very important point which is this is not a strategy that's in place already in countries including high-income countries so every country is going to have to work very hard and is going to have to innovate around systems to actually deliver vaccines that do have an ultra-cold chain. Part of the approach that many countries may take is to choose to use vaccines that require an ultra-cold chain for only certain portions of the population that need to be vaccinated; for example using that vaccine among healthcare workers where facilities might be the place where immunisation would take place and therefore installation of a -70 freezer would be more simple, recognising also the need that you described for electricity to be maintained in those facilities. 00:12:53 So I think the main message is that we do have technology, there is demonstrated experience of delivering ultra-cold chain vaccines even in some of the most difficult and remote areas but that has also taken enormous resources to do that. So what we need is a variety of vaccines that have different characteristics and, as you know, in the past several weeks have been through press release, the release of efficacy data on other vaccines that are either kept at -20 or at refrigerated temperatures, which will certainly ease the distribution and use of vaccines so I hope that answers your question. MH Thank you. I'm looking in the room to see if there's anyone else who wants to add anything. I think not. Do we have anyone on the line who would like to add? No so we'll go to the next question which is from Helen Branswell. Helen, could you unmute yourself and ask your question. 00:13:55 HB Hi, thanks for taking my question. Hello to you all. Can I ask about vaccines and herd immunity? [Unclear] get a sense of how efficacious these vaccines could be, are we able to calculate how many people in a population would need to be vaccinated to get to herd immunity? Is it something that is achievable at this point? KOB Another great question. The concept of herd immunity of course is the idea that there can be people who have the appearance of immunity, in other words are protected against disease, but themselves are not actually vaccinated and the way that that happens is that at some point the number of people around them in the community are themselves immune and as a result the non-immune people are protected because the virus or the pathogen simply has very limited ability to move around in the community so just for those who maybe aren't familiar with what herd immunity is I'll just clarify that. 00:15:11 Helen, the point about herd immunity is really what is the performance and the ability of the vaccines or frankly natural infection to protect against future infection and therefore acquisition and transmission to somebody else. What we really need to know is what the vaccines are being developed, each of them; what their ability is to interrupt the acquisition of infection but it's not the only way that herd immunity can be achieved. We do want to know about whether there's a reduction in people getting infected in their nose, in their respiratory tract even without getting disease; but also do the vaccines change the amount of time that you're actually infected, does it change the density of the infection and does it change the transmissibility to another person? Those are all really important characteristics. We don't know the proportion of the population that would need to be immunised because we haven't observed that yet but the answer to that can come from modelling studies that tell us under certain conditions what proportion of the population would need to be immunised. A number of those modelling studies have been done and under a variety of conditions have concluded that somewhere around 60 to 70% of the population would need to be immune - presumably through immunisation - in order to achieve a reduction or an interruption in transmission of the virus. 00:16:52 That's of course predicated on what the performance of the vaccine would be so it's really important that we start to get more information about what the vaccines do not just for preventing disease but for actually preventing the acquisition of the virus, an infection and the characteristics of that infection. MR Thanks, Kate; really clear. Just maybe to add that we also need to continue our understanding of the transmission dynamics of the virus because it clearly does not spread through a community in a common linear way and herd immunity concepts are built around that idea, that the disease spreads evenly through the community and that everyone's absolute risk of being infected is about the same. Then if you have lots of protected people surrounding those who are unprotected then effectively there's a barrier, there's a firewall around someone who's not vaccinated, a firewall of vaccinated people and therefore you can achieve control and eradication sometimes without vaccinating everybody. That's the principle, I think, of herd immunity. 00:18:05 But what we've seen with this virus is - I won't define it as cleverness but the virus is very opportunistic and we've seen that the virus can spread in particular circumstances. We've seen in many clusters that only 20% of the cases go on to transmit to others, 80% don't transmit to anybody else. We've seen super-spreading events, certain contexts and certain groups who mix and the disease can explode. So it may be that it will take some very clever vaccination strategies to highly target people in our society who are more likely to carry, transmit and super-spread with this virus. So just using an absolute number, Helen, may not be the best way. I think we'll need some numbers to guide us in terms of policy but I think we'll need to be much more surgical and precise in exactly who we target for vaccination. It may be much more important to target certain sections of the community than it will be necessarily to target some others who may not be participating in transmission as much. So I think the answers will come based on what Kate has said but we also, I think, need to remain vigilant. As long as there's a potential for super-spreading events there's always the chance that a very small incidence can lead to a large cluster of cases even in the context of high levels of vaccination. 00:19:27 I think we will need to be very, very careful to make sure we send the right messages to people. Vaccination will have a major impact on mortality, we hope. We hope it will have a very major impact on transmission and control but I don't think anyone can promise eradication of this virus until we understand much more about the vaccine and much more about how the vaccines work in the real world and until we understand much more about the details of transmission of this virus. KOB That's such a great point, Mike. I just want to give an example to bring it to life a little bit. Last year in 2019 we had a terrible years of measles outbreaks around the world and many of those outbreaks were happening in countries that had very high measles vaccine coverage but it wasn't the whole country's coverage that was important; it was about the sub-communities, the subnational coverage. 00:20:24 So you absolutely can have lower vaccine coverage in a community that is a big enough community where a virus can spread so I think Mike's made a really good point, that we shouldn't be anchoring on a hypothetical number from modelling that somehow is going to be the whole country's coverage but it's really about where is the virus at any given time and how much of a firewall is there for the virus in that community at that time when there are infectious people in the community. I hope that gives an example of what Mike was trying to explain. MH Thank you, Dr O'Brien. I think Dr Soumya Swaminathan would like to add something as well. SS I wanted to make a very quick point, Helen, because we were talking about vaccines with over 90% efficacy here. That's what we've seen from a couple of the early results. Just to point out that MRNA vaccines are particularly good at stimulating innate immunity and so what you see in the short term - we've only got data for two months of follow-up - could be the effect of a non-specific innate immune response plus specific immunity. So while we hope that these vaccines do have over 90% efficacy it would be wise to wait a little bit to look at the follow-up results from people in this trial and that's why it's so important that the trials are continued, that they continue as placebo-controlled, double-blinded trials as long as possible, as long as it's ethically and practically feasible to do that because there are a lot of questions that we still need to understand particularly, as I said, about duration of protection, about the impact on severe illness and on transmission of infection and about the efficacy in different sub-populations including the older-age adults. 00:22:29 Just something to keep in mind especially when we see these very, very high efficacy read-outs is that we do need data over longer periods of time to make sure that those are actually the long-term protective effects. I just wanted to say that in addition to what's been said by Mike and Kate. Thanks. MH Thank you, Dr Swaminathan. Our next question comes from Jamil Chaid from Brazilian media. Jamil, unmute yourself please and ask your question. JA Thank you, Margaret. Thank you for taking my question. This is a question to Dr Ryan. Could you tell us a little bit of the scenario for Brazil at this current stage? Can we talk about a second wave already in terms of Brazil or has the first wave never ended for us to be calling it a second wave? What lessons from Europe could Brazil learn in this potential second wave? Thank you. 00:23:46 TAG Yes, I think there are lessons there for all of Central and South America. Most of Central and South America went through a very tough time in terms of cases and deaths and the numbers have progressively fallen in most countries over a couple of months but now we see the prospect of numbers increasing again. I think there are lessons to be learned from North America, lessons to be learned from Europe. I think what we've seen is where countries have taken decisive action to try and reduce community transmission they've managed to turn that curve around but that's taken quite a deal of co-operation from people in terms of understanding the need to do more physical distance and to really focus on mask-wearing, to focus on hygiene and in some cases to accept restrictions; restrictions of movement and so-called lock-downs. That's a very difficult thing to enact, particularly in highly populated areas where many people are dependent on going to work and on day salaries, where poverty is an issue and it's very hard to expect people to give up their only access to socio-economic gain by staying home. 00:25:02 So I think the lessons we're seeing now in Europe certainly is countries that act early and act decisively get a benefit and that the transmission turns around relatively quickly once you're able to make a community-based intervention and particularly when the community come on board with that. We've seen a significant shift in behaviour in countries towards people really working not only on avoiding transmission in large settings or in the public environment but really looking at transmission in the household and trying to reduce the risk of secondary transmission at home, which has become a major factor in Europe and in North America for transmission; focusing on protecting yourself and protecting others, that individual education, individual knowledge transfer and getting that clear and consistent messaging out. I think Europe this time around has done a much better job in having consistent processes across all of - let's look at the European Union; the member states of the European Union have aligned better on the types of measures, they've looked the same in how they've approached things much, much more. 00:26:18 There's been a consistency in that messaging and if you see the European Union as a federation of states and you look at a very large country like Brazil or other large federated states that ability to negotiate with and reach consensus with subnational entities and find consensus on how to move forward together so that populations get clear and consistent messaging, clear decisions on public health action, clear decision on mandates that are to be implemented by government; I think that's what we've seen. We've also seen previously for example, the Brazilian health service reacted wonderfully to the last surge in cases and certainly so many brave front-line health workers in Brazil but they were pushed to the very limits of their capacities both in terms of equipment and their own fatigue. Therefore it's going to be very important as numbers increase that they are protected, that the health system is protected from a large surge of cases. You cannot assume that a health system can take the same beating a second time around and what we have seen too as case fatality rates have dropped in every age group is higher recovery rates for all age groups over the summer. 00:27:38 That's been very much down to doctors and nurses having more time with patients, having more time to give clinical care. If we get back to a situation where intensive care units are overwhelmed we will see the death rates rise again unnecessarily so all of the things we've said before; what we need now is to do it quicker, to do it more consistently in a more co-ordinated way because we've learned what works. There is an excuse the first time around; we're all learning, we're all adapting, we're all testing what our populations will accept or won't accept. A second time around you need to have done that learning and understand how to do better this time. I think countries in Europe have really tried to look at how they can improve what they are doing and I think they have improved this time around and hopefully there are lessons there and learnings there for countries who may now be entering a second surge or a second phase. Maria. 00:28:37 MK Yes, I'd like to add to what Mike has said there. As he said, there're a lot of lessons to learn. I think one of the messages we need to continue to say is even as case numbers are coming down all countries need to remain vigilant. You've heard us say this before but we really need to emphasise this again; do not let your guard down. It is good to see the measures taking effect and transmission going down but it is not time to let up and it's time to even scale up. In situations where you're bringing this under control it is time to scale up your public health infrastructure still; work on making sure that you have adequate workforce to do active case finding, to conduct those tests, to use those tests strategically, as you've heard us say many times and the Director-General emphasise again today; to work to have your health systems be ready for any potential resurgence. That includes making sure you have ample hospital beds, ICU beds, supplies, PPE for your staff. It is still time to scale up. I know that probably sounds like it doesn't make sense; the case numbers are going down, why do I need to scape up? It's just using the time appropriately to prepare and to revise. As Mike has said, we're learning and so you can tailor your approach to be more agile, to where it's needed and need those resources best if you have any resurgence and be very quick and decisive when there is a resurgence. 00:30:13 So the earlier action you have, if you have that resurgence, the quicker you can prevent cases becoming clusters and clusters turning into community transmission. But what we don't want to see is situations where you're moving from a so-called lock-down state to bringing the virus under control to moving to a so-called lock-down state. It's really important at that time when transmission is brought under control that we don't give up, we don't let our guard down. We still need to ensure that everyone remains vigilant, everybody knows that this is not yet over. We're working towards bringing this over altogether but we still need to think about what we do every day, we still need to take a risk-based approach throughout the actions that we have every day until this pandemic is over. 00:31:03 I think that we just need to make sure that we just don't let up and I think that's something that we have to hammer in because there is no reason to have a second surge, there is no reason to have another wave or another surge. It is within our power to be able to keep transmission low and we've seen dozens of countries show us that it can be brought under control and it can stay under control. MH Thank you very much, Dr Ryan and Dr Van Kerkhove. The next question goes to Bayram from Anadolu. Bayram, can you unmute yourself and please ask your question. BA Thank you, Margaret, for taking my question. According to certain sewage samples in Marseilles, France, it seems cases of COVID-19 already started to die [?] before France put the country into lock-down, which could mean that the lock-down was not really efficient. Some specialists even said getting people confined in close settings at home increased the cases after the start of lock-downs and that is also visible in sewage samples. Do you have any comment on that? Thank you so much. 00:32:20 MH Your question was about whether or not lock-downs work and do they exacerbate transmission by confining people. Is that correct, Bayram? BA It is correct, yes. MK Thanks for that question. It's a very important one because if people are asked to stay at home and there are stay-at-home orders and there is virus circulating in the community if there is somebody who is infected and they're put in the home there's the possibility that the virus can transmit within the home. That's why one measure alone is not enough. We need to make sure that in addition to any measures that are put in place we still are conducting strategic testing for any cases who are suspect cases; they receive a test and then the public health actions are followed. So if a case is identified make sure that they are isolated in a medical facility and all cases need to be isolated in a medical facility or at home away from others. 00:33:18 In the situation where people are going home all at once we need to make sure that if we're feeling unwell we stay away from others in our home, we wear a mask in the home and others in the home wear masks, especially people who are feeling unwell. But there is a risk that by putting people all at home you can put the virus there and it can spread but again we need to make sure that these confinement measures or these stay-at-home measures are not used in isolation. They have to be used with other measures as well. The stay-at-home measures do take the heat out of transmission in some respects in terms of transmission in the community but it is possible that it brings it home so you have to take the precautions at home as well. MH Thank you very much, Dr Van Kerkhove. The next question is from Shane Ju from CCTV. Shane, could you unmute yourself and please go ahead. SH Okay. Thank you, Margaret. My question is for Dr Ryan. It's a follow-up question about his comments last time on the virus origin. Dr Ryan, as you mentioned during the previous briefing there is increasingly more and more evidence of the existence of this virus in other species and in waste water or patients around the world. 00:34:32 You also mentioned some cases were not directly linked to Wuhan seafood market in the first [?] outbreak and... not sure yet where the first case of breaching the species barrier... and maybe the market was only the place for amplification. There is also new evidence, they say, suggesting that the virus existed long before the outbreak in Wuhan. For example the Italian researchers found the virus in samples from last September. Does that mean that the case zero or several cases zero could be outside of Wuhan, outside of China and is there a possibility that the virus already circulated in humans outside of China before the outbreak in Wuhan but without being noticed? Thank you. MR Thank you. Yes, I think we need to be careful with our speculation here. There are lots of different observations that have occurred around the world but the idea that humans can infect minks and minks can infect humans is very clear but there's no evidence that mammals in a European environment were the source of this disease originally for humans or outside China. 00:35:44 The issue for us and from our perspective - and again Dr Tedros, myself and others have been clear on this from the beginning and this is why we sent an advance team to China; this is why we've been discussing this issue since February, since the first research and development roadmap where the animal origins studies were seen as a top priority; this is why the World Health Assembly discussed this and issued a World Health Assembly resolution 73.1 identifying the origin studies as a very important issue, which was consensus between all member states. This is why we sent an advance team to China, to look at the issues and negotiate on the best possible way to move forward with studies. We identified in the terms of reference two phases of studies. Phase-one studies really identify many of the questions you've laid out there or laid out within the phase-one studies that we've agreed with our Chinese colleagues. We've had a high level of engagement with those colleagues at a virtual level. Peter Ben Embarek is here and I've asked Peter to give you an update on the nature of those discussions but it is clear from a public health perspective that you start your investigations where the human cases first emerged. 00:37:00 In that regard and the first cluster of cases - and again the astute clinicians in Wuhan picked up a cluster of unusual, atypical pneumonia and to an extent probably because there was an association in time and a geographic association with the market it triggered in their minds a suspicion and they reported that disease to the appropriate authorities and then there was a subsequent investigation. So from that perspective that was the event which triggered the response and the investigation and that's very important and the physicians and others and the people involved in that initial detection deserve credit. The question then is what was the original origin of the virus and nobody has that answer and that is what the phase-one studies were to be about and are about and there's a series of phase-two follow-up studies planned once we have the answers to those questions. 00:38:01 So we believe we need to make progress on those studies and understand what our Chinese colleagues have investigated, the results of those investigations and we are working with them to send a team to the ground to both review the results of the phase-one trials and look at other studies that may need to be done. After that the evidence should take us where we need to go but to speculate on where the virus emerged precisely without starting where the human disease emerged for us doesn't represent the best way forward. However at the same time we are working with scientists all over the world, we are open, we receive information. There are publications being made almost every week on animal studies and we will continue to track that and we will take every detection in France, in Spain, in Italy very seriously and we will examine each and every one of them. We have taken action directly with researchers - Maria may speak to that and how we've engaged with researchers who've published unusual results from other countries to try and validate those results as well. 00:39:09 So I think it's highly speculative for us to say that the disease did not emerge in China. What we do know is the first clusters of human cases that were detected were in Wuhan in China. There was a massive response to contain that disease there and we look forward to working with our Chinese scientific colleagues to understand better the origins of the virus within China or beyond China, wherever that leads. Peter. PBE Yes, as you said, the international team has started to work with their counterparts in China updating each other in existing and past studies and ongoing studies and we are starting now to discuss the famous phase-one studies, the studies that need to be conducted in and around Wuhan to look at what happened back in late 2019. We need to push back our understanding of what happened before the detection of the initial cases. We have to make the link between that event and the original animal that was the source of this virus. We know that the virus belongs to a group of viruses that have their natural niche in bats, in certain families of bats but between bats and the event in Wuhan we have a big gap and that's the purpose of all theses studies, to fill that gap and understand what happened between these two events and where it happened. 00:40:52 But for the time being we have to start where we have the first solid clues and these are the first detected human cases in Wuhan in late 2019. MK Thanks. Just a couple of comments to add on to what Mike and Peter have said. There is some additional work that is ongoing as well looking at some waste water studies. Some countries have looked at retrospective samples of waste water. There was a study that hasn't been published that had one sample, that they found RNA but that hasn't published. There are other studies that found RNA in December in Europe, in Italy. There's one study that was published very recently, a serologic study, seroassay study looking at some samples from Italy from a cancer screening institute in the fall. They found seropositive samples in December using an Eliza test and in October using microneutralisation. We have reached out to these researchers and they have generously offered to work with us and to collaborate with us on some further studies looking at those samples, just making sure that we can do some further studies with samples from that cancer institute. 00:42:14 In addition to that there are a lot of analyses that are ongoing looking at genetic sequences so as you know there are more than 200,000 full-genome sequences that have been made available. This is an incredible global collaboration of researchers all over the world. We still need more so please continue to share those sequences. Then there are phylogenetic analyses and there are really incredible scientists that are looking at these to look at how this helps shape our understanding of this virus and the way that this virus moves. So there are a lot of sources of information but as Mike and Peter have pointed out studies need to begin where the first cases were detected, in Wuhan where those first cases were detected in December and then we follow the science wherever the science leads us in terms of further investigations and studies that need to be undertaken. 00:43:07 But there's a wonderful global collaboration that is ongoing and these studies will be conducted. MH Thank you, Dr Van Kerkhove. One more. Sorry, Dr Tedros. TAG On the study of the origin of the virus one thing that has to be clear is the study will start from Wuhan in China, where the first report came from and then from there based on the findings we can go anywhere so I think it's better to really underline that. Thank you. MH Thank you, Dr Tedros. The next question goes to Stephanie Nebahe from Reuters. Stephanie, please unmute yourself and go ahead. ST Thank you. Thanks for taking my question. I wondered if either Kate O'Brien or Dr Soumya would like to comment on the AstraZeneca results and the idea of needing further... a new trial in effect to check the findings of the lower dosage, the efficacy of the lower dosage, that first part. I wondered if you think that is necessary and whether the current results are reliable enough to give regulators a full picture. Thank you. KOB I can start and then pass over to Soumya. I think the first thing to say is what we've seen is a press release and what is really the next most important step is that the data really needs to be evaluated based on more than a press release. First of all there's only a limited amount that can be said in a press release and secondly it really needs to be reviewed in terms of the data and questions asked about the data that may come up in the course of the review so it's difficult to weigh in on this. 00:45:29 I think what we can emphasise though is that from what we understand about the press release there is certainly something interesting that has been observed but there are many reasons that could underlie the differences that were observed. So certainly more information is needed and that includes evaluations of the immune response in the trial as well. So I think it's too early for us to say anything about what we make of the data and what is needed next. What we really need to see is more than a press release; to really see the data and have a chance to ask the questions that are needed. I'll pass it over to Soumya. SS Thanks, Kate. Just to add to that, again what we know is what we've seen from the press release and it appears that fewer than 3,000 people were given the schedule with the half dose followed by the full dose of the vaccine and we also understand that those people were all under 55 so they didn't have anyone over 55 in that group. 00:46:44 Whereas the other group of about 8,000-plus people who were given the full dose and the full dose; there were larger numbers and it also included different age groups so it's very hard to compare these two groups and I would say the numbers are still small to really come to any definitive conclusions. Of course the advantage of using a smaller dose, particularly if you're getting a higher efficacy, is great as you can save on the vaccine and at the same time you're benefiting from higher efficacy. But I think it would be speculation at this point and we've heard from AstraZeneca that they would like to do a full trial of this schedule because the other trials that are ongoing now are the two full doses. So if we are to explore this hypothesis of having perhaps a better efficacy with a lower dose then it would need a trial. The last point I'd make is that this is the reason that WHO actually convened experts very early on in the pandemic to really start thinking about what should be the benchmarks, the target product profiles for a good vaccine and also thinking about what would be a good trial design really to answer the questions around efficacy and prevention of severe disease and prevention of infection as a secondary endpoint. 00:48:13 We worked with statisticians, with experts to really come up wit what a trial design would look like and I must say that it's been very encouraging to see that many of the manufacturers and developers have actually published their protocols so you can see exactly how they're going to do it, what they're going to do, at what steps they're going to do the interim analysis, when they're going to unblind the data and what the primary and secondary endpoints are both for efficacy and safety. So I think that transparency and sharing is extremely important for scientists to evaluate, to compare also between different vaccines because let's not forget, we have dozens of vaccines in the pipeline and we are going to be in a situation where we might have a variety of different vaccines with a variety of different results and people are going to have to make decisions and choices. 00:49:13 So it's really good to have apples to compare with apples and therefore for all trialists - and perhaps this is a plea to those who haven't yet published their protocols and made them available. It's easy for the regulatory agencies as well. It's good for organisations like the WHO that have to make decisions based on comparisons and it's good for citizens also in that it generally builds a trust in the process of vaccine development. Thank you. MH Thank you, Dr Swaminathan and Dr O'Brien. The next question goes to Shoko from NHK. Shoko, can you unmute yourself and ask your question. SH Hello, Margaret. Can you hear me? MH Very well. Please go ahead. SH Thank you for taking my question. Dr Tedros just mentioned the study of the origin of the virus will start in China but is the international mission going into the field in Wuhan? Thank you. TAG Yes, that's correct. It will travel to Wuhan. Thank you. MH Thank you. That was an easy question. The next question goes to Musa from Al-Mayadin TV. Musa, please unmute yourself, go ahead and ask your question. 00:50:47 MU Are you listening? MH Very well. Please go ahead. MU My question is in Arabic, please. TR The question is for the Director-General. You always ask for vaccines to be spread out fairly, to be distributed fairly. Are you asking for help for poor countries from rich countries or from industries that produce the vaccines? Is the WHO able to offer all or part of these vaccines freely to poor countries? A question for Ms O'Brien; what about the Russian vaccine compared with other vaccines? Do you have any data on the Russian vaccine? Thank you very much. MH Thank you. Yes, this sounds like a question. The first question's about COVAX really, about distribution of vaccines and the second one is specifically for Dr O'Brien. Dr Aylward, are you online? If not we can start with Dr O'Brien and then move over to Dr Aylward. How about that? Dr Mariangela Simao will be able to speak to that as well, I think. We'll start with Dr O'Brien. 00:52:12 KOB Thank you. I'll start with some comments on the fair allocation of vaccines. There is, as I think people are aware... WHO has through the ACT Accelerator and the COVID vaccine component of the ACT Accelerator... and is a partner in the COVAX facility which is the global mechanism for all countries around the world to aggregate demand and the financing for vaccines and to assure that there is fair and equitable access through the WHO fair and equitable access mechanism, which can be then applied to those vaccines that are procured through the COVAX facility. That facility has a component of the facility for the 92 countries that will be supported for the procurement of vaccine and it also includes a part of the facility where countries who are wealthier countries would themselves pay for vaccines that are procured through the facility. So there is a mechanism for all countries to have fair and equitable access and for those countries that are not able to themselves afford vaccines to be supported to do that. That support is coming from overseas official development assistance and from contributions from other sources and there is of course a relationship for entering into contracts with manufacturers and those discussions with manufacturers are well underway for the facility with a number of agreements made already and others that are fully being developed at this point. 00:54:09 Perhaps Mariangela would like to say a little bit more about the allocation. We have developed an allocation mechanism that Who has led and that really is about allocating vaccine in a fair and equitable way across all of the countries. For the first 20% all countries would receive vaccine in an equal rate and following that for vaccines beyond the 20% of the population, for countries that want to go beyond that level there may be consideration if we're still in supply shortage about... The pace that countries would get vaccines would account for vulnerability and the threat of COVID but I'm sure Mariangela may want to say more about that. On the issue of the Russian vaccine, the Gamelaya vaccine, again we've had a press release from the Gamelaya vaccine in the past several days, reporting very high efficacy from this viral vector vaccine. This is also very welcome news along with the other three manufacturers that have reported efficacy data but I want to emphasise again what we emphasised before. 00:55:29 These are data that have been reported through press releases and what is really important and critical at this point is for those data to be reviewed by regulators and reviewed at WHO also for policy reasons and for regulatory reasons, for WHO pre-qualification or emergency use listing and for those data to be in the public domain through the usual mechanisms that are used, which is through the peer-reviewed publication process. So we're really eager to see the results of all of the reports and of any vaccine that is able to report results from phase-three clinical trials on the prevention of disease. I don't know if Bruce is on the line or if Mariangela would like to join in or Soumya. Thank you. MH Dr Mariangela's on the line, I believe, so over to you. MS Thank you and thank you, Kate, for a very... I almost have nothing else to add except on the allocation because I think Dr O'Brien has explained quite well. But I would like to add regrading the vaccines, the Russian vaccine and... because - have mentioned in weeks before - WHO has issued an expression of interest to assess for emergency use listing candidate vaccines in phase 2B and phase three and this expression is still open. 00:57:03 There are several of the advance candidates in phase three that have expressed interest and are in discussions with WHO, exchanging information. As Dr O'Brien has mentioned, we still have to see not only the clinical data but also the good manufacturing practices data that are part of when a country does an emergency use authorisation or WHO does an emergency use listing. It's based on a series of important information, non-clinical, clinical and referring to manufacturing practices. This is work ongoing and I think Dr O'Brien has explained quite well the allocation. Thank you, Kate. MH Thank you very much. Dr Tedros has something to add. TAG Yes, thank you. With regard to vaccines, when we started the ACT Accelerator we had two objectives. The first one is accelerating or speeding up development of products and the second objective fair distribution. 00:58:15 Based on that we have been working and now there are three critical elements for the success of the ACT A; one, finance and I think we have said it many times. We need US$4.5 billion immediately. Second it's political commitment. Probably you have followed the G20 summit and the UN General Assembly. Many countries are committing to use vaccines for COVID as global public good, meaning to share it fairly so the political commitment is important. We have it now, of course a pledge but that has to be translated into action because we're going to have the vaccines now so the political commitment will be real when we see it in action; that's second. Third, we have to prepare countries for vaccination and strengthening the infrastructure will be important. As one of the journalists asked, some of the vaccines need -70 degrees centigrade refrigeration so we may have those vaccines; we may have other vaccines that could be refrigerated between two and eight degrees. 00:59:42 But we have to prepare the system for any eventualities or the infrastructure of countries and that's why we have co-signed a letter with the World Bank, UNICEF and the Global Fund to our country offices to prepare and support countries for vaccination. These are the critical issues; finance, political commitment that can be translated into action and preparing the infrastructure. This will result in sharing. Sharing of the vaccines fairly means faster recovery for the world. This is in the interests of each and every country. It's only together that we can recover faster. It's through sharing that we can recover faster and it's only through sharing that we can take care of lives and livelihoods. Thank you. MR I'd add one thing, something, Dr Tedros, I think we should say because in my experience in emergency response and in other infectious diseases in situations like this we tend to be unfair first, inequitous [sic] and then eventually the glaring gap is so big and with activists from community level and others the world has to turn around and find a way to be fair. 01:01:17 In my professional experience this is the first time that fairness and equity were built into this project from day one and that was under the leadership of Dr Tedros and other leaders who came together and implemented by people like Dr Mariangela and others and a wonderful team. But that would not have happened unless someone had stood and said, no, this will be done but it will be done with fairness and equity as its central tenet. In my view that has then created and driven one of the most effective public/private partnerships in the history of science when you think about where we were ten months ago and we're not there yet. As Soumya says, we're at the base camp and we have to climb the mountain. But the very fact that we have the opportunity to climb that mountain and bring everyone with us is incredible and we thank you for your leadership, Dr Tedros, and for the way in which you've reached out to partners all over the world to deliver this. In addition, as someone who works in humanitarian response, this is definitely the first time, in addition to that fair distribution, that there's a specific allocation of 5% for the humanitarian situations in which we may not be able to access people through normal programmes. 01:02:26 That has never happened before because it is the refugees and the displaced of the world who are the most forgotten and it is just wonderful for me as someone who works in the humanitarian space and I thank you on behalf of all of those people we serve for that being at the forefront of the decision-making in that regard. So thank you, Dr Tedros, for your leadership. MH Thank you. On that note this is the moment to close the press conference. I think a very, very important point has been made here. I would like to thank everybody. Those who did not get questions, please contact us via media enquiries and we will of course post all the audio file, the transcript and everything else on the web as soon as possible. I'll now just hand back to Dr Tedros to say goodbye. MH Thank you, Margaret. In my statement earlier I said COVID-19 is an uneven pandemic and 70% of cases and deaths are in just four countries but I would like to correct this and I would like to thank Kai for keeping us on our toes. What I should have said is that almost half of all cases and deaths are in just four countries and almost 70% of cases and deaths are in the top ten countries so apologies for the error. I'm really sorry for any confusion we caused but thank you, Kai, for keeping us on our toes. Thank you and I would like to also thank all our colleagues here, starting with our interpreters and also to the media who have joined today. Thank you so much and see you in our upcoming presser. Thank you. 01:04:29