00:00:54 FC Hello, all. I think our technical problems are being solved now. I am Fadela Chaib, speaking to you from WHO headquarters in Geneva and I welcome you to our global COVID-19 press conference today, Friday 8th January. Present in the room are WHO Director-General, Dr Tedros, Dr Mike Ryan, Executive Director, Health Emergencies, Dr Maria Van Kerkhove, Technical Lead for COVID-19, Dr Bruce Aylward, Special Advisor to DG and lead on the ACT Accelerator, Dr Mariangela Simao, Assistant Director-General, Access to Medicines and Health Products. Joining us remotely are Dr Kate O'Brien, Director, Immunisation, Vaccine and Biologicals, and Dr Ed Kelley, Director, Integrated Health Services. Welcome, all. We have simultaneous interpretation in the six UN languages plus Portuguese and Hindi. Now without further delay I would like to invite Dr Tedros for his opening remarks. DG, you have the floor. TAG Thank you. Thank you, Fadela, shukran. Good morning, good afternoon and good evening. COVAX, set up by GAVI, CEPI and WHO in April last year, has now secured contracts of two billion doses of safe and effective COVID-19 vaccines, which we're ready to roll out as soon as the vaccines are delivered. 00:02:31 We also have the right of first refusal on an additional one billion doses. However this is where the current challenge is. At present 42 countries are rolling out safe and effective COVID-19 vaccines. 36 of these are high-income countries and six are middle-income countries. So there is a clear problem that low and most middle-income countries are not receiving the vaccine yet. This is a problem we can and we must solve together through COVAX and the ACT Accelerator. At the outset rich countries have bought up the majority of the supply of multiple vaccines. Now we're also seeing both high and middle-income countries that are part of COVAX making additional bilateral deals. This potentially bumps up the price for everyone and means high-risk people in the poorest and most marginalised countries don't get the vaccine. 00:03:42 Some companies and countries have not submitted critical data which we need to issue emergency use listings, which blocks the whole system of procurement and delivery. Vaccine nationalism hurts us all and is self-defeating. But on the flip side vaccinating equitably saves lives, stabilises health systems and would lead to a truly global economic recovery that stimulates job creation. Importantly it would also help us limit the virus' opportunity to mutate. The current variants show that the virus is doing its best to make itself more suitable to ongoing circulation within the human population. This is normal of every virus but at present we're helping it thrive if we don't reduce transmission and vaccinate equitably. Going forward I want to see manufacturers prioritise supply and roll-out through COVAX. I urge countries that have contracted more vaccines than they will need and are controlling the global supply to also donate and release them to COVAX immediately, which is ready today to roll them out quickly. And I urge countries and manufacturers to stop making bilateral deals at the expense of COVAX. No country is exceptional and should cut the queue and vaccinate all their population while some remain with no supply of the vaccine. 00:05:33 Science has delivered. Let's not waste the opportunity to protect the lives of those most at risk and ensure all economies have a fair shot at recovery. It is a massive undertaking to ensure health system planning, co-ordination, training and logistics are set and able to roll out vaccines in the midst of a COVID-19 surge. The 100/100 initiative driven by WHO, UNICEF and the World Bank is supporting over 100 countries to conduct rapid readiness assessments and develop country-specific plans for vaccines' deployment. We have hit our target; 100 countries have now completed this critical process and the governments and health systems are on stand-by for global vaccine roll-out. We're ready, COVAX is ready, countries are ready. The time to deliver vaccines equitably is now. This is a very dangerous time in the course to the pandemic and I do not want to see people become complacent as vaccines are starting to roll out. Over the past few days we have seen some of the highest numbers of deaths recorded at any point in the pandemic. 00:07:03 This is happening because over previous weeks there has been a lack of compliance with what health authorities are advising in several countries. The virus has taken advantage of this and is spreading at alarming rates in some countries. You might think that it won't happen to you and that you don't need to comply with the measures. The problem is that before you know it not complying a bit becomes a habit, people you know mimic the behaviour and the whole system breaks down. Not complying with recommended measures gives the virus opportunities to spread, putting you and your loved ones at risk of infection and for more people to develop severe disease and for more pressure to be put on health workers. People need to know that they can personally stop the virus and they need to know that the virus can stop with them. If I said one thing to people in areas where there are high numbers of cases it would be to do all you can to avoid mixing with people from other households, especially inside, because the virus thrives when people gather in groups, especially inside where people are less inclined to physically distance. 00:08:44 Wear masks and hand wash where windows aren't open and there is not adequate ventilation, which means everyone is sharing the same air. In this difficult period it's best to meet virtually but if you have to meet others do it carefully and with the right precautions; meet outside wherever possible. None of us are exceptional and the more we can break the chains of transmission and stop the virus ourselves the more we will avoid severe cases and tragic deaths. This year is the year of the health and care worker. Let's show our respect and appreciation for health workers and care workers by protecting each other and vaccinating all health workers everywhere now. Remember, ending this pandemic is one of humanity's great races and whether we like it or not we will win or lose this race together. I thank you. Fadela, back to you. FC Thank you, Dr Tedros. I will now open the floor to questions from journalists. I remind you that you will need to raise your hand using the raise your hand icon to get in the queue. I would like now to invite our first journalist, Jeremy Launch from RFI, Radio Internationale. Jeremy, can you hear me? 00:10:33 JE Yes, Fadela. Can you hear me? FC Yes. JE Thank you so much. Good evening. A quick question on the new study that suggests that the Pfizer vaccine protects against the new variants of COVID. I would like to know if WHO has more details on that and what about the other vaccine, probably AstraZeneca and Moderna? Do you have info that they too protect against the new variants? Thank you so much. FC Thank you, Jeremie from Radio France Internationale. I would like to invite Dr O'Brien to take this question. Dr O'Brien. KOB Thank you for this question. We're looking into this very recent information and I think the important thing is this is going to be a dynamic situation and the evidence is going to continue to accrue so this is welcome information. It's also what has been expected, understanding where the modifications are that are part of these variants so this is certainly a dynamic space and there will continue to be work going on to look at the relationship between these variants and the vaccines, a number of vaccines coming out. 00:12:05 In particular I think what is also anticipated is evidence from efficacy trials that re being conducted in areas where the variants are circulating and that of course will be some of the most powerful information that will come out about these vaccines. FC Thank you, Dr O'Brien. I would like now to invite Jamil Chad from EOL to ask the next question. Jamil. JA Yes, can you hear me? FC Yes, very well. Go ahead, Jamil. JA Thank you for the question, Fadela. My question is probably to Dr Mike Ryan. It's a question about Brazil. Could you tell us what is, in your view, the current situation in Brazil, especially in the state of Sao Paulo, whether you think it is time, as WHO already asked for others in terms of Europe and other regions of the world, to make restrictions more solid or increase restrictions at this point in time? 00:13:12 Where are we now, at what point are we in Brazil today and can you comment on the specific situation of regions? Thank you very much. MS Hi, Jamil. This is Mariangela. I will come in there. I think we are observing the data from Brazil very carefully and it's actually evolving differently in the different regions of Brazil. It's welcome news that the Brazilian producer, Butanta, has made public the news about the efficacy of the Sinovac vaccine so we're watching the situation in Brazil as it evolves. Of course, as I said, being a big country, the different regions are showing different signs either of stabilising the epidemic, the number of cases or increasing in some regions, especially the south-east and the south of Brazil. I don't know if Mike wants to come in. MR Just to add that, like many other countries, the latest surge in cases has been pretty much country-wide. We've seen again the healthcare system impacted but the number of available ICU beds remains adequate in most regions although some areas have now over 70, 75% of ICU occupancy. Remember in previous surges that went up to nearly 90 or over 90% in some cases so the health system continues to cope. Brazil is essentially in the same situation that many, many other countries are, dealing with a third surge, second surge, whatever you call that and keeping the health system online is extremely important. 00:15:09 The DG has spoken to what we all need to do to reduce the force of transmission within our communities. The same advice goes to everybody in Brazil and again we're all struggling with this virus at this moment in time in different countries for different reasons. FC Thank you. Maria. MK Yes, thanks. Just to supplement this to say, it's not Brazil-specific but I think it's a good opportunity to remind everyone that the epidemiology needs to drive the response so regardless of where you are and what is happening the data that is captured from the systems that countries have put in place which are being implemented through the surveillance activities and active case finding, through your testing, through your cluster investigations; that data should drive what you do next. 00:16:01 So while we see now strong national plans with strong strategies the implementation of the public health and social measures, as those are applied, as those are lifted need to be guided by the epidemiology of the local situation so taking decisions at the most local level possible. What we are seeing is what countries are doing is looking at agile and tailored approaches based on the need, based on the capacities and adjusting as necessary. These are strengths of the responses that we are seeing at subnational levels; course-correcting, making those adjustments to what is needed, using your workforce as best you can, the tired and overworked and exhausted workforce, through contact tracers, through those that are doing lab tests, through those community health workers that are going door-to-door, to your front-line medical workers. Use your workforce as best you can where they are needed but base it on the data that's driven and that is something that I think is worthwhile reminding because as we see case numbers go up and down in many different locations the response has to be guided by the epidemiology. 00:17:10 Whether this is a virus variant or not it needs to be based on the local epidemiology that you're seeing and use the tools that you have on hand and use the vaccines and vaccinations as the come online but use everything at your disposal to reduce the spread. As much as we can limit the number of infections this will have a positive impact on reducing the burden on the health system, it will reduce the number of people that will develop severe disease, the number of people that will need hospitalisation and ultimately the number of people that will die. FC Thank you. I would like now to invite Nina Larson from AFP to ask the next question. Nina, are you with us? NI Yes, hi. Can you hear me? FC Very well. Go ahead, please. NI Thanks. I was hoping you could provide us with an update on the international mission to China, if the Chinese officials have provided you with an explanation for why visas were not provided earlier this week and when you think they'll be expected and also where the two experts who set off on Tuesday are now. Are they still waiting? Thank you. FC Dr Tedros. 00:18:25 TAG Yes, thank you very much. We're in touch with Chinese officials and they agreed to share with us the specific dates for the travel in the next few days and we will share with you the specific dates next week. We're also advised that the visa and other needs are on their way so we will give you more details next week but we expect to fix travel dates next week. Thank you. MR I'd just supplement to say that the two experts who had begun travel have returned to their home stations and we, including the Director-General, spoke with them at the weekend but also today we had a meeting of the international team. We continue to remain fully committed to the detailed planning for the mission on the scientific basis. We had a very good meeting today to discuss that and we will reach out once again to continue that scientific collaboration with the colleagues on the science side in China so we fully expect to continue that planning in terms of the terms of reference and the objectives of the mission, the specific scientific investigations and enquiries that need to move ahead. 00:19:44 As the DG said, the other arrangements around the logistics are in hand and we stand ready and are on stand-by to move as quickly as those issues are resolved. FC Thank you. I would like now to invite Michael Buzietkiv from CNN Opinion to ask the next question. Michael, can you hear me? MI Yes, I can hear you. Can you hear me? FC Very well. Go ahead, please. MI Super. Thank you for taking my question. I recently had the chance to interview Dr Michael Osterholm. He is a member of President-Elect Joe Biden's COVID-19 advisory board. He said quite grimly the following; the coronavirus is like a series of forest fires looking for human wood to burn. Likely well over 65 to 75% of the world's population has yet to be infected and indeed just today LA County said they're observing a test positivity rate of 20 to 25%. So my question is the following; given the slow pace of the vaccine roll-out, new spikes in regions that had earlier crushed the curve [?], vaccine hesitancy and given the faster spread of the virus from the newer strain, what is your best estimate on what percentage of the world's population will become infected at the end of the day after all is said and done? Thank you. 00:21:15 MR Hi. Thanks. Mike has said many very, very wise things right the way through this pandemic and continues to do so. The reality is you lay out some very tough realities as part of your question. The DG has said it before; we are in the fight of our lives. We're at a moment when the virus transmission is intensifying because of our behaviours. It's intensifying because of variant strains and we're continuing to track the movement of the virus as it finds susceptible individuals and continues to infect them. Mike is correct in that it is like a series of forest fires where there are large numbers of susceptible people and the virus enters that group, it spreads very quickly and then makes those people who are vulnerable very sick and many die. The reasons for that are the way in which we're mixing and allowing the virus the opportunity to transmit further. The virus is not stopping in each generation with each individual. The virus is continuing to find ways to move to the next generation of infection and causing havoc as it does so. 00:22:38 The measures the DG has outlined and that Maria emphasised are still the same measures. We can still stop this virus. We can still interrupt its transmission. We have to double down and recommit ourselves to that process. Mike is correct; the vast majority of the population of this planet still remains susceptible to infection with this virus. It's very, very difficult to come up with an actual, accurate figure for how many people have actually been infected. Many of the seroprevalence studies have occurred over the past year; many are six months old at this point so we're dealing with older data. Maria can speak to how we're trying to address that number but Mike is correct when he says up to three-quarters of the population and potentially more are still susceptible to infection with this virus. So this fire, to use his analogy, will continue to burn. It will continue to burn until we put the fire out. We can and need to put this fire out. We need to dampen the intensity of the flames. 00:23:37 We can only do that right now through the measures we take individually and collectively and at government level to do that. We need to use all the tools, as Maria has said many times, in that toolkit. We have the tools, we have the means to do that. The vaccine is rolling out, it will continue to roll out and it will provide a huge opportunity to save lives and it will ultimately provide an opportunity to dampen and shut down transmission. But that day has not come yet and we need to buy time, we need to buy time and save lives until that happens. If we cannot get vaccines - and the DG has spoken to this as well - we do not want to see a prospect where we see large proportions of people vaccinated in some countries and no-one vaccinated in other countries. The people likely to die from this infection are not everybody in every country. It's very particular risk groups by age and by vulnerability who are likely to get very sick and likely to die. It is front-line health workers who are exposed to this virus every day. This is whom we need to protect first. It's not about the overall percentage of the population that's susceptible. It's not about the overall percentage of the population that will ultimately be infected. It is, are we going to allow those people who are vulnerable and those people who are most at risk to get sick and die from this virus. 00:25:02 That is what the DG has spoken to, the need for us now to take a step back and ensure that we distribute this vaccine to those who need it, to those who are most vulnerable and those who are going to benefit most. But again Maria may speak to the issues of how we're trying to get to a better number in terms of those who are susceptible and Bruce may want to comment on the issues of vaccine distribution. MK Thanks, Mike. Yes, indeed, I think the forest fire analogy is really a good one and if you've heard us speak before many times about the idea when we think of transmission as cases, sporadic cases, those sporadic cases could be embers, these could be little tiny sparks that could potentially turn into small fires which are clusters of cases and those clusters of cases could turn into wildfires which are community transmission. 00:25:56 All of the measures that we have outlined through this comprehensive, all-of-government, all-of-society approach are working towards making sure that those embers, those sporadic cases do not become little fires or clusters and that those little fires or clusters do not become community transmission and those wildfires. That is what countries are showing us they can do so I think that fire analogy works really, really well because we have tools in our toolkit that put out those fires. Those tools that we have break those chains of transmission and prevent the sporadic cases from becoming clusters and those clusters from becoming community transmission. Those same tools help us move from community transmission to clusters and from clusters to sporadic cases and we've seen that in many, many countries across the world, in all regions of the world, in different types of societies, high-income, low-income, urban, rural over and over again and that will be done again and vaccines and vaccinations will be one more powerful tool to help us put out those fires. But with regard to the serology, indeed there are hundreds of studies that have been done that have looked at specific populations and amongst those populations how many of those individuals have had evidence of infection. 00:27:14 They look at a point in time and most of those studies have been done up through the spring and into the summer in the northern hemisphere so April, May, June, July, August and they have given us almost a point estimate. In that population between three, five, maybe 10% of that population has evidence of infection. What we are working towards through our Unity studies - and this is a programme that we have begun in January where we with our partners have developed protocols, research templates which we have shared now with more than 100 countries, we are working with them to adapt these research protocols for the countries themselves. We're providing technical support, operational support. We're even providing the serologic assays that they can use to follow populations over time so that we can get estimates of the populations that have this evidence of infection. 00:28:11 Our goal in doing so using a standardised approach is to be able to pool that data either regionally or globally so that we can come up with estimates to answer the question that you asked in your question to us today. But we're also looking at the immune response over time. There are some recent studies that have come out even today or yesterday that suggest that the immune response may be six months or longer and that's very good news to show that somebody that was infected, even if they had mild disease, develops a robust immune response and that immune response lasts for six months or longer so that's good. We're still studying this so while there are hundreds of studies underway we don't have all of the answers yet but the results that come to us, that are shared with us in real time almost tell us that the majority of the world remains susceptible to infection and therefore we have to do everything that we can to prevent as many infections as we can. We will emphasise that every time we have an opportunity to do so because this matters. Every step that you take that reduces your exposure reduces the opportunity for this virus to infect you and it reduces the opportunity for you to pass it on to someone else who may be of a vulnerable group, who may be of an older group, that would develop severe disease, need hospitalisation and potentially die. 00:29:38 While we have got better at treatment there are still a large number of people who are dying from this virus so it's up to us; as the DG said today, the virus can stop with us. We need to do what we can to make sure that we break those chains of transmission; first of all not let you get infected but if you are infected let the virus stop with you. FC Thank you so much. I would like now to call on Jason Bobien from public national radio, NPR, to ask the next question. Jason, can you hear me? JA Yes, thank you very much. I want to ask about the variant, the B117 which originated in the UK. There is a lot of concern about how transmissible it actually is. What do you have in terms of clarity on exactly how much more transmissible this is and is there adequate monitoring globally to actually detect these changes and report these variants? Thanks. 00:30:49 MK Thank you for the question. The virus variant identified in the United Kingdom is B117. We are working with our colleagues in the UK and in fact as we sit here just now they've just released their third technical briefing online. That has just come out from Public Health England. We meet with our colleagues regularly there and they're looking at a variety of factors related to this virus variant. One of the issues they're looking at is transmission and the way that they're evaluating transmission is looking at the data captured through their surveillance system, through the molecular testing, the PCR testing, the antigen base testing but also the amount of cases that are sequenced. They've done some modelling studies, they've done some phylogenetic analysis which is analysis of the full genome sequences that have been made available across the country and they're doing some studies in the lab looking at the viral loads of individuals infected with this variant compared to other SARS-CoV2 viruses. What we understand from their studies that are ongoing - and again these are ongoing studies and they're constantly updated with more information - is that the virus variant, this B117, is more transmissible than the wild-type SARS-CoV2 virus is. 00:32:07 They have estimated through their modelling studies that the increase in transmissibility as measured by the reproduction number, which is the number of cases an infected individual would infect, has increased from about 1.1 to about 1.5 or 1.7. That's also been analysed through the phylogenetic data. They've seen increases in transmission across all age groups and that's a reflection of the mixing patterns and the transmission that has happened in south-east England, in London and across other parts of the UK. They've also measured viral load, which is the amount of virus detected through the testing systems that they have and they have found that people who have been infected with the virus variant, the B117 have a higher viral load compared to others with the wild-type virus. But we did specifically speak today about the way that the virus transmits or the modes of transmission and there is no difference in the way that this virus transmits and that's important because we need to constantly look at the measures that are in place, the personal protective equipment that is being advised. 00:33:17 They are discussing that with their expert groups in the UK and they have not changed their recommendations on PPE but it does mean if you have a virus that is more easily transmitted you have to work that much harder in breaking those chains of transmission. It is important to note that the tools that we have against normal SARS-CoV2 virus - which is dangerous enough - work against the virus variant that was identified in the United Kingdom and separately also against the virus variant that was identified in South Africa as well. So they are continuing to do studies. We're very grateful for all of the collaboration across Public Health England and the many different academic groups and modelling groups and the front-line workers and the studies that are ongoing and quite literally are sharing these results with us in real time. So thanks for that question but an increase in transmissibility, no change in disease presentation or severity, which I don't think I mentioned, but that has been confirmed through the cohort study that they have ongoing looking at rates of hospitalisation -so no change in hospitalisation of people infected with the virus variant compared to the other SARS-CoV2 viruses - or in mortality. 00:34:34 MR Just to add that WHO and partners; we're fully activated on monitoring the emergence of variants and the evolution of this virus and have been for months with the virus evolution working group which involves scientists and labs from all over the world. We are issuing guidance to countries today - thank you, Maria - on specific epidemiologic and laboratory surveillance for these variants, which is supplementary to previous advice put out there. Our global epi team is working on an epidemiologic analysis right now looking at signals for unusual epidemiological events that may be occurring in relation to variants around the world. 00:35:17 It's important that our work is epidemiologically driven and that we're using epidemiology to drive our lab investigations and, as I said, the virus evolution working group continues to work. The vaccines group is also working very hard and next week there will be a specific programme on research and development for RUPE [?] and for epidemics. We'll be hosting two meetings next week, one specifically to look at the emergence of viral variants and one looking specifically at the research needed around vaccines in relation to the same issues and beyond; the vaccines meeting is broader but it will consider the variant issues as well. Much work is underway as well looking at the long-term effectiveness or functioning or performance of diagnostic tests, looking at the lab assays, also looking at continued effectiveness of monoclonals and polyclonal antibodies and then with vaccines so that work is underway. All of that needs to be further brought together, different, very important strands on this but Maria is correct; we're not seeing a clinical signal that this disease is more severe. The evolutionary pressure on the virus is - and this is what viruses do; they tend to become fitter. They become better adapted to transmission in humans and with higher viral loads they're more likely to cause transmission. That is in the interest of the virus; that's a positive evolutionary outcome for the virus, not for us. 00:36:48 In that regard there is no signal at this point of any change in clinical severity and that's very important to recognise. We've also had meetings today with our strategic and technical advisory group on infectious hazard, which is chaired by David Hayman from the London School. We've considered these issues as well. Next week we will have our meeting of the Emergency Committee on the IHR, which will consider these issues as well. In addition we've been working with the Global Influenza Surveillance and Response System. The GISRS system has been providing vital monitoring of COVID-19 around the world through severe acute respiratory illness and ILI surveillance and we've been able to track the overall impact and presence of COVID around the world over the last number of months. We're currently working with them to see how we can adapt that and enhance that to do more of the genetic monitoring as well and in addition working on expanding genetic sequencing capacity around the world, particularly in low and middle-income countries. I know there are some excellent projects out there led by the Wellcome Trust and others looking at how we can rapidly further expand the capacity to do genetic sequencing and genetic surveillance as such on this virus. 00:38:04 So many, many strands of activity from the vaccines to the labs to the epidemiology to the transfer of knowledge and technology and capacity and we will continue to do so and keep you informed of progress. Again though I think it's important to recognise that we've had variants before emerge - the D614G and others - and these variants will continue to emerge as the virus evolves. We're in a race against the virus in that sense but we should also remember, as Maria said, that the way in which this virus is transmitting has not changed. We still have the capacity to suppress that transmission if we do the right things and we will continue obviously to study the long-term impact of any of these variations on diagnosis, on therapies and on vaccines. But rest assured, this is in hand and we are looking very, very closely at this. We take these developments very seriously but we also need to remain focused on the job at hand which is breaking chains of transmission and getting vaccines out to those who need them. Thank you. 00:39:09 FC I think Dr Van Kerkhove would like to add something. MK Just to say we can share the guidance that was issued today. There were two pieces of guidance issued today related to sequencing. We've had a lot of people ask us questions about how much we need to sequence and how we do that. So we've issued in our disease outbreak news which was on 31st December some preliminary recommendations on who to sequence, which cases to sequence, recognising that sequence capacity is not at the level that we need it around the world and also that you don't need to sequence every single case that's out there. But as Mike has said, leveraging the systems around we have really worked very hard with our flu network to be able to build diagnostic capacity as well as use the sequencing to do that. We've issued two guidance today. One is interim guidance which is a recommendation on who to test, who to sequence. 00:39:59 What we want to focus on is sequencing a subset of cases that are in your country based on capacity but also especially focusing on any cases that are part of clusters that may be different than what you would expect. For example in the United Kingdom they noticed that there was an increase in transmission in late November/early December when they didn't expect there to be increased transmission because there were some interventions in place. They were in tier-two and tier-three lock-down. So they went back and looked there and did some sequencing. But also if you see any change in disease profile, difference or severity those would be good cases to sequence. That's a good place to start but we've issued some guidance with more specificity in there for the lab programmes in each country to look at. Also we have a much larger implementation guide on how to set up sequencing which is a much bigger project because it's very labour-intensive and quite expensive but we're working with countries to be able to increase that capacity with the public health labs in country but also leveraging academic labs and private labs that can do sequencing as well. 00:41:03 Because, as you pointed out in your question, we need to be able to detect and detection of these mutations and detection of these variants comes from the full genome sequencing so being able to do that helps us have eyes on these viruses and how the viruses change but also sharing those viruses, sharing those sequences with public databases like GISAID for example. That allows scientists all over the world to do these beautiful trees and phylogenetic analysis of actually tracking it over time. As Mike has outlined and as you've heard us say, there's a comprehensive risk monitoring framework around mutations and variants so that we can have a robust process to determine which ones are important and why and what is the public health impact of any of these that are identified. 00:41:54 MR I just wanted to add one thing; sorry for taking the floor again. As the UK have assigned the value to this, calling it a variant of concern, I think it's important to reflect on that. There are lots and lots of different variations in the virus. Every virus you sequence will be slightly different. What UK have identified through epidemiologic investigation first and then identifying a variant was associating that variant with a change in the epidemiology and then labelling that a variant of concern. I think that's what we're after; we're after being able to detect not just variations in the virus but being specifically able to identify variations of the virus that are of concern for public health, for transmission, for severity. That's the job; picking out of the noise, picking the needle in the haystack, picking out the signal for the virus as it evolves, whether new versions of the virus evolve that are of more concern for us in terms of our ability to control it or in terms of its severity. Again just to say, the Governments of the United Kingdom and of South Africa and Nigeria and other countries are doing a fantastic job in stepping up on this issue of genetic surveillance and monitoring this at a much more enhanced level and therefore it's really important that when people call this a UK variant or a South Africa variant we're not assigning values to these countries. 00:43:13 These countries are not the cause of this problem. They're actually defining solutions by giving us the information that we need and they should be commended and lauded for having invested in the kinds of systems that allow us to do this kind of monitoring. We should be following their example rather than looking at these as problems generated by or in South Africa or in the United Kingdom. The Government, the public health, the labs, the clinicians and others in those countries should be... I think South Africa is a beacon in terms of the comprehensiveness... and the way South Africa has been able to pull together data from many, many different sources again shows that this old idea of the north/south divide, that countries in the south can't do as well as countries in the north when it comes to doing this hardcore epidemiology in the lab; this is about access to technology. 00:44:01 Other countries in the south can do this as well. They don't necessarily have access to the technology and the training and the resources to do it but South Africa has clearly shown, Nigeria has clearly shown that if they have those resources, if they have access to these technologies they will get on and do exactly the same job as is done in the north. FC Thank you. I would like now to invite Catrine Fionco Bokonga to ask the next question. Catrine, can you hear me? CA Yes, thank you, Fadela. Thank you for giving me the floor. My question is regarding the types of vaccines. Africa, which has problems getting access to the vaccines for the moment, is turning to the Chinese Sinopharm vaccine and Guinea started vaccination with Sputnik 5. Could you give us more information about those vaccines and also maybe the price? If I understood, vaccines like Pfizer and Moderna that are using new technology are ten times more expensive than AstraZeneca, Oxford or the ones that are using a more traditional method of vaccination. Thank you very much for your answers. FC Merci, Catrine. I would like to invite maybe Dr Aylward to start. 00:45:41 BA Sure. Thank you, Catrine. You've asked about the types of vaccines. Dr Tedros in his opening comments highlighted that there're 42 countries around the world that we know are now vaccinating with COVID-19 vaccines, the majority of these of course in the industrialised world - sorry, in high-income countries and a small number in the upper middle-income countries, about six. There's very limited if any vaccination... A lot of what you've referred to are actually plans, not actually the roll-out of products yet and sometimes just exploratory discussions. But in the places that have started vaccinating there've been six vaccines that are in use right now, among them the ones that you mentioned. These are a range of vaccines from MRNA vaccines, as you said, all the way to inactivated vaccine products. At this point we're aware of two of those vaccines that have gone through stringent regulatory authorities in multiple countries, one approved by a stringent regulatory authority in one country. One has been, let's say, emergency use listed by WHO and that is the Pfizer product that we've seen. 00:46:59 Others are in the pipeline now for evaluation very, very rapidly. We are aware that some countries have made decisions to proceed with vaccines that have been approved through other mechanisms. We recognise that and we are continuing to work with both the countries to support the decision-making that they may make in that regard and understanding the issues around that. But we're also working very hard with the companies that are producing these products to make sure that they can be assessed by WHO through its regulatory support processes so in the process of looking at those products. As you know, we are not in a position to provide a perspective on vaccines that are in use that we've not seen the data on and at this point, as I say, the vaccine that we have seen is the Pfizer vaccine. We have all of the data on that. We also recognise of course in this exceptional circumstance vaccines that have been approved through stringent regulatory authorities and now those are the Pfizer vaccine and the Moderna vaccine and then one country having approved one other vaccine at this point through a stringent regulatory authority. I think Mariangela wanted to add. 00:48:22 MS Can I just complement from the regulatory side. First of all countries have the autonomy, according to their legislation, to issue emergency use authorisation for health products according to their own legislation. But WHO does have a process which most of you are aware of which is the pre-qualification process and in the case of new vaccines like the COVID vaccines we do an emergency use listing assessment. We have issued an expression of interest, received 13 valid proposals since October and besides the Pfizer vaccine which was already listed by WHO we do have other products that are at an advanced stage. Specifically in the products that you have cited we have received already - and this information is public, it's published on WHO's website. We have received for example the full dossier from Sinopharm, which has finalised its phase three trial and has been authorised in some countries. We are in the process of receiving the complete data from AstraZeneca, from the Serum Institute and we expect to receive additional data from the Gamaliya, which is the Russian producer, before the end of January. 00:49:51 This is just to say that these products are currently being assessed by WHO. This is important not only because many countries rely on WHO's assessment for authorising the use of the product in their own country but also because it helps the international procurers like UNICEF and others to procure the vaccines that have been assessed by WHO. Thank you. FC Thank you. I think Dr Aylward would like to add something. BA Yes, I also want to come back in on the point that when people ask our opinion on the products - I'm sure the journalists with us today will appreciate, for us to provide an opinion on a product that we've actually not seen and seen the data behind would be inappropriate and unfair to those asking the opinion. We also have to be very clear though; a neutral perspective. Some of these products may turn out to be great products and extremely important in the battle against COVID-19. This comes back to a point that the Director-General made in his opening comments. We've put together a fantastic facility to help make sure vaccines get rolled out equitably around the world. The fundamentals are completely sound. That mechanism can only work if vaccines come into it and go through it as well as money. We don't print money and we don't make vaccines. This is where we need the manufacturers working with us and we need the donor countries and others working with us and working together. 00:51:24 If a company does not submit the data that we need it is slowing equitable access to vaccines around the world. If a company doesn't sign and work the deals through with us and if we don't have the financing to do it they are slowing equitable access. The Director-General, I think, was very frank about that today and what we're calling for in this frank call to action in the Director-General's speech is access to the data on all of these products in real time as it's coming out so that we can ensure that we can provide a perspective on these products as rapidly as possible and get them out equitably around the world. Michael asked an excellent question earlier and then Maria was responding to it, talking about the tools. The problem we have is the tools aren't equitably distributed. Look at the map of the world. There's a huge part of the world that's not vaccinating yet. 50% of the high-income countries in the world are vaccinating today. 0% of the low-income countries are vaccinating. 00:52:27 That is not equitable access, especially when we know - and Mike made this point - that the people at risk of dying are older people. There're older people everywhere in the world. The people at most risk of exposure to this are those front-line workers. These people are working around the world but they're not being protected at the same rates. That's why we've created COVAX. It is there, it works but it needs the vaccines and financing. We have part of the financing in place. We are ready to go, ready to get started. We need the manufacturers working with us and we need the countries working with us. We have to change the colours of those maps this month. FC Thank you, Dr Aylward. I think Dr O'Brien also has something to add. Dr O'Brien. KOB Yes, just two things to add to what has already been said by Bruce and by Mariangela. The two additional points I want to add have to do with transparency and with policy. In addition to the procurement, the money that Bruce has spoken about and the need for the data on regulatory issues, in addition countries do rely on WHO for recommendations on how to use the vaccines especially because these vaccines are in limited supply in the initial phase of roll-out - we know that - all over the world. 00:53:56 Choices do need to be made about how best to use them to their best impact, the maximum impact especially in these very early phases. We do need to see the data on these products in order to establish policies, as SAGE did at the beginning of this week. The second thing is transparency on information. Our understanding of which countries, where they're using vaccines, what deals are being done is extremely important in order to help with this whole process of equitable allocation and equitable access to vaccines. We're also calling on countries and manufacturers to be clear and transparent about where vaccine deals are being done, the doses that are being arranged for use in various countries and then their actual roll-out. Having this information over time is really important for WHO and for the world to respond to this crisis in a way that will have its maximum impact. I think those are the two other points to make here. Thank you. 00:55:12 FC Thank you all. I would like now to invite Christopher Hamill-Stewart from Arab News to ask the next question. Christopher. CH Hi, can you hear me? FC Yes, very well. Go ahead, please. CH Great, thank you. I wondered if the WHO had a response to Iran's announcement today that it would ban the import of US and UK vaccines. FC Thank you, Christopher. Dr O'Brien, do you want to respond to this question, please? KOB As Bruce has just indicated, there are a number of vaccines on the market that are available around the world and especially in the COVAX facility the importance of having a portfolio of vaccines that serve the different needs of different countries and especially serving the different needs of delivery situations. We know of the different products that we have some require an ultra-cold chain, some require a frozen temperature that's not ultra-cold and some require refrigeration. 00:56:20 So we have a lot of variability of the products in terms of a range of their characteristics. I think the other important thing to say in relation to this is that there is manufacturing going one of these products in different places around the world and that provides greater or lesser access to different vaccines. So I think the range of needs of countries and choices of countries is served by having this portfolio of vaccines where there can be matching of vaccines to the delivery needs and the characteristics that countries have for the access to those vaccines. FC Thank you. I think Dr Aylward wanted to complement. BA Yes, thank you, Fadela, and thanks, Kate. Super-important questions about vaccines and vaccine access that we keep coming back to and we're going to come back to them more and more as we go forward over the coming months. 00:57:20 The important thing to recognise is that every country in the world is making decisions about what products it does and doesn't want to use and prioritises and doesn't prioritise for different reasons. One of the things that we've been doing as part of the COVAX facility is going out and talking to the 90-plus countries that are what we call our AMC countries and our other participants; we have 190 participants. We get back a wide range of preferences on what kind of products they want to use, whether they want to use more than one product, two products, which particular products they may want to use and for a whole wide range of reasons. I come back to that perspective that the Director-General comes back to again and again about the importance of not singling out individual countries or issues and really focusing on how we get these products to as many countries as necessary. One of the beauties of the COVAX facility the way we've set it up is we've got a very broad portfolio of products, we know we have a broad range of clients that we're working with through that, participants and what we're going to do is work with them to get that right balance of products. Again it's one of the reasons that this facility is such an important part of the global solution to equitable access and roll-out. Every country needs these products, every economy needs these products right now and it's really time to put any kind of politic aside and make sure that vaccines get to the people that need them. 00:58:50 MR I think Bruce said it. The DG has said many times in the past, let us not politicise this virus. Please let us not politicise this vaccine either. FC Thank you. I would like now to invite EFE, Antonio Broto, to ask the next question. Antonio, can you hear me? AN Yes. Can you hear me? FC Yes, very well. Go ahead, please. AN Thank you, Fadela, for taking my question. Global figures for daily cases of COVID in the first days of this year are not higher than in December despite the virtual [?] spike in transmissions after the Christmas and New Year holidays. Do you think that this is a good sign, maybe a sign that the vaccines are already working or is it too soon to be that optimistic? Thank you. 00:59:43 MR I think it's way too soon to be that optimistic. The reality is for the third week in a row we've had over four million cases reported each week in this pandemic. There's been a very slight decrease in the last week but again the transmissions that would have occurred over the holiday period will only be pushing through into the numbers that we're seeing this week, next week and beyond. So no, it is way too early to interpret that. What we do know is certainly in the northern hemisphere there's been a tremendous amount of mixing of people over the last number of weeks and, as has been previously stated, we're dealing with the complications of variant strains and potential increases and transmission. So no, there's nothing to suggest that. The numbers of vaccines that have currently been distributed will have had zero impact on transmission by now at country level. They maybe are saving lives as we speak and we're very grateful for that but they're not going to affect transmission dynamics for a very long time. Bruce. 01:00:50 BA Just to the point that Mike made, the last point was so important, the last part of that question about whether or not we're seeing the impact of the vaccines already and the answer is no. These vaccines and the way we're rolling them out have two really specific goals. Our first; save lives, get them to the people at highest risk of dying of this disease. We know those populations; they're the older people in our societies; so important that they get protected early. We know the people who are getting exposed at a disproportionate rate and especially those front-line workers who unfortunately have been giving their lives to try and save lives during this crisis. We've got to protect those people first so that's what our initial goals are. We do not have the volumes, they don't exist yet and we also don't know all the mechanisms of these vaccines to be having an impact on these curves; much, much too early. As we look into our crystal balls we're not going to see that in the coming six months. As we scale up these vaccines over time - it comes back again and again to what Mike has been saying; the Director-General. This is not going to work if people are mixing at high rates, if they're not using masks, if they're not doing all those things that are so important. 01:02:07 Vaccines have a lot of promise but what we need to do now is identify the cases rapidly, the mild cases, the moderate cases that are driving this crisis, get them isolated, identify the contacts, get them quarantined. That plus the roll-out of these vaccine is what is going to see those curves change. But it's not going to change just by those drops of vaccines that are going out at the current rates and they're only going to go out... We've seen all the challenges to getting the numbers up even in highly advanced environments so it's absolutely imperative that the other parts of this response work and we start applying the knowledge we've learned in the 12 months that we've known this virus. FC Thank you. Maria. MK Yes, thank you. I have to come in on the aspects of the consequences of our action and the Director-General said it in his speech tonight. The results of our actions over the last five, six weeks are what is resulting in increased case numbers, in increased hospitalisations and in increased numbers of deaths and that will continue for the coming weeks and the coming months if we do not change our behaviour. 01:03:21 You have to follow the local advice that being advised in the areas where you live. Governments need to enable populations to be able to do so. If you are asked to stay home we understand that that is challenging in many different respects of our daily lives and our social lives and many situations. People need to work to put food on the table so we need people to be supported in the actions that are advised by governments but we also need individuals to think about what they do every single day. The decisions that you make every single day about what you want to do versus what you need to do matter. They can have consequences of increasing transmission and they can have consequences of decreasing transmission. Please help be part of the solution of decreasing transmission. There are actions that you can take right now that limit the exposure to yourself and to your loved ones. Maybe you don't think that COVID-19 is a big deal for you but it can be because we know that this virus is dangerous, this virus can cause severe disease and it can kill you and maybe not you, maybe someone that you love that has an underlying condition or is of older age. 01:04:33 This is serious and at the present time in many countries we're seeing increased transmission where we can turn the corner by putting in the measures at home, staying home if you're unwell, staying home and not mixing with other families, postponing that trip that all of us want to take, making sure that all of the actions that are put in place... If you are asked to be in quarantine please stay in quarantine. You are adding to the solution here. If you are a case - and we hope there are no more case but if you are a case staying in isolation, making sure that you receive the adequate care that you need in medical facilities, allowing the community workers to do contact tracing and cluster investigation and the technicians to do lab tests and get those test results back quicker. But all of those actions can reduce transmission and we are pleading with everyone to do everything that they can to be part of the solution to break those chains of transmission. It is within our hands. Vaccines and vaccination are another powerful tool but it will take time. In the meantime there is much that you can do every single day so please help be part of the solution. 01:05:46 FC Thank you, Maria. I think Dr O'Brien wanted to say a few words. Dr O'Brien, you have the floor. KOB Yes, really important things that everybody has said about this, Maria in particular just now but we've been saying about the vaccines, even anticipating that they were coming even before they came, that it was not going to be a flip of the switch and even as they roll out we actually don't have the information right now about the magnitude, the degree to which they actually interrupt transmission. So although we do have evidence now about the degree to which they can protect against disease and especially severe disease that does not necessarily imply that the same magnitude of impact will be on the protection against transmitting from one person to the next person. So I just want to reinforce that even for people who have been vaccinated - and there will be an ever-increasing number of those people - that does not mean that people who have been vaccinated are now fully protected from getting infected in their nose. 01:06:53 They are very substantially protected against themselves becoming ill but we have evidence from a very new study that a 59% estimate from a model of the transmission is coming from people who are not symptomatic at that point in time. So we really do need as we roll out the vaccines to remember, as Maria has said, this is just one tool, a new tool and a very powerful tool in the toolkit but it doesn't mean that we should step back. In fact we should be escalating and improving our use of all the other tools that we already have. Thank you. FC Thank you, Dr O'Brien. Antonio's question was the last one for today. Over to you, Dr Tedros, for final words. Thank you. TAG Thank you. Thank you so much, Fadela. Thank you, all colleagues from the media, for joining and look forward to seeing you in our upcoming presser. Have a nice weekend and Happy New Year. FC Thank you, DG. Just to remind journalists, we will be sending the audio file and the DG's speech right after this press conference. The full transcript will be posted soon on the WHO website. As usual do not hesitate to contact the media team if you wish to ask any follow-up questions. Thank you and have a nice weekend. 01:08:19