WHO press conference on COVID-19, monkeypox and other global health issues – 5 October 2022 – who.int

Overview

00:00:27

MH Hello, everybody. This is Margaret Harris in WHO Headquarters, Geneva, welcoming you today, October 5, to a media briefing on the many major global health issues that WHO is currently responding to. As always, well open with remarks by our WHO Director-General Dr Tedros Adhanom Ghebreyesus, after which we will open the floor to questions from media representatives.

Joining Dr Tedros in the room are, Ill go from left to right, Dr Maria Van Kerkhove, Technical Lead on COVID-19 and on Dr Tedros right is Dr Sylvie Briand, Director, Epidemic and Pandemic Preparedness and Prevention, Dr Abdi Mahamud, Acting Director, Alert and Response, and Dr Soumya Swaminathan, our WHO Chief Scientist.

00:01:17

Online, we also have many experts, including Dr Mike Ryan, our Executive Director, World Health Emergencies, Dr Rick Brenna, our Regional Emergency Director for the Eastern Mediterranean Region, Dr Palitha Mahipala, our WHO Representative in Pakistan, and we have even more, a big range of subject-matter experts whom I will introduce to you as they answer your questions.

I have to apologise in advance. We do not have simultaneous translation today, as we have a number of major global meetings going on at the same time as this press conference and so it was not possible to arrange the simultaneous translation. I apologise for that. But now, without further ado, I will hand over to Dr Tedros. Dr Tedros, you have the floor.

TAG Thank you. Thank you, Margaret. Good morning, good afternoon and good evening. First to Uganda, where WHO is continuing to support the government to respond to an outbreak of Ebola disease in four districts. So far, 63 confirmed and probable cases have been reported, including 29 deaths. Ten health workers have been infected, and four have died. Four people have recovered and are receiving follow-up care.

WHO has released US$2 million from our Contingency Fund for Emergencies, and were working with our partners to support the Ministry of Health by sending additional specialists, supplies and resources. When there is a delay in detecting an Ebola outbreak it is normal for cases to increase steadily at the beginning and then decrease as life-saving interventions and outbreak control measures are implemented.

00:03:19

The vaccines used successfully to curb recent Ebola outbreaks in the Democratic Republic of the Congo are not effective against the type of Ebola virus that is responsible for this outbreak in Uganda. However, several vaccines are in various stages of development against this virus, two of which could begin clinical trials in Uganda in the coming weeks, pending regulatory and ethics approvals from the Ugandan government.

Now to Pakistan. Although the waters have stopped rising, the danger is only increasing. More than 1,500 lives were lost in the floods but many more could be lost to disease in the coming weeks without a massive and urgent international response. WHOs Executive Director for Health Emergencies, Dr Mike Ryan, has just led a team to Pakistan to assess the needs.

Approximately 10% of all of Pakistans health facilities have been damaged, leaving millions without access to health care. Stocks of essential medicines and medical supplies are limited or have been washed away, damaged roads and bridges are impeding access to services and supplies, and disease surveillance and referral mechanisms have been severely disrupted. There are now outbreaks of malaria, cholera and dengue, an increase in skin infections, and we estimate that more than 2,000 women are giving birth every day, most of them in unsafe conditions.

WHOs focus is on supporting people in four groups, those in camps, who we access easily but are a small percentage of the total need, those who are living along the roadside for hundreds of kilometres, those in areas cut off by flood waters, who are very difficult to access, and those in areas where the water is receding, and are returning home to destroyed villages and homes.

00:05:47

In August, WHO released US$10 million from our Contingency Fund for Emergencies but this massive and unprecedented disaster needs a massive and unprecedented response. Today, we have issued an appeal for US$81.5 million to support WHOs work to support the delivery of immunisation and other life-saving health services, to address severe acute malnutrition, to enhance disease surveillance and to strengthen water and sanitation, and we urge our donors and partners to support this effort. In the words of the United Nations Secretary-General Antonio Guterres, this is not about generosity, this is about justice.

Now, to COVID-19. Several countries in Europe are now reporting an increase in COVID-19 cases, hospitalisations and deaths. This is to be expected as the weather cools and people spend more time together inside and most countries no longer have measures in place to limit the spread of the virus. We expect reported cases of COVID-19 to increase but the deaths dont have to, given we have vaccines and therapeutics that can save lives.

Omicron remains the dominant variant globally, and WHO and our partners are tracking more than 300 subvariants but surveillance, testing and sequencing remain weak globally, which makes tracking this virus like chasing shadows. So, we continue to call on all countries to increase surveillance, testing and sequencing, and to ensure the most at-risk groups are vaccinated.

At the same time, the Northern hemisphere influenza season is starting. Measures introduced to curb the spread of COVID-19 during the pandemic also helped to reduce the burden of flu but, with most of those measures lifted, flu is back and should not be taken lightly. Flu vaccines are safe and effective in reducing severe disease and death, especially among the most at-risk groups, so please get your flu vaccine.

00:08:33

Another disease making an unwelcome comeback is cholera. After years of declining cases globally, we have seen a worrying upsurge of cholera outbreaks around the globe over the past year. In the first nine months of this year alone, 27 countries have reported cholera outbreaks. Not only are we seeing more outbreaks but more deadly outbreaks. The data we have, which are limited, show the average case fatality rate so far this year is almost three times the rate of the past five years. In Syria, more than 10,000 suspected cases of cholera have been reported just in the past six weeks.

And in Haiti, after more than three years with no cases of cholera, two cases have been officially reported this week in the capital Port-au-Prince, with 20 suspected cases and seven deaths under investigation in other areas. Its likely the actual number of cases is significantly higher. This outbreak is a particular setback as Haiti was preparing to be certified as cholera-free later this year.

Although cholera can kill within hours, it can be prevented with vaccines and access to safe water and sanitation, and can be treated easily with oral rehydration or antibiotics for more severe cases but the reality is that many people dont have access to these simple interventions.

00:10:33

In 2013, WHO and our partners created an international stockpile of cholera vaccines which last year shipped 27 million doses but, with an increasing number of outbreaks, supply cannot keep up with demand. We urge the worlds leading vaccine manufacturers to talk to us about how we can increase production.

Cholera thrives on poverty and conflict but is now being turbocharged by climate change. Extreme climate events like floods, cyclones and droughts further reduce access to clean water and create the ideal environment for cholera to spread. Cholera is deadly but its also preventable and treatable. With the right planning and action, we can reverse this trend.

Finally, WHO has today issued a medical product alert for four contaminated medicines identified in The Gambia that have been potentially linked with acute kidney injuries and 66 deaths among children. The loss of these young lives is beyond heartbreaking for their families.

The four medicines are cough and cold syrups produced by Maiden Pharmaceuticals Limited, in India. WHO is conducting further investigation with the company and regulatory authorities in India. While the contaminated products have so far only been detected in The Gambia, they may have been distributed to other countries. WHO recommends all countries detect and remove these products from circulation to prevent further harm to patients.

Ebola in Uganda, multiple outbreaks in Pakistan, cholera around the world, the ongoing COVID-19 pandemic, the global monkeypox outbreak, the annual threat of influenza, and contaminated medicines all illustrate why its so urgent that all countries, individually and as a global community, invest in strengthening their defences against outbreaks that can devastate families and communities, and cripple societies and economies.

00:13:37

In particular, it shows why cost-effective investments in disease surveillance and primary health care are so important. Emergencies are an unfortunate fact of life. We might be able to prevent some but we cant prevent them all. But by investing in strong health systems at the local level, we can mitigate the impact emergencies have and save many lives. Margaret, back to you.

MH Thank you very much, Dr Tedros. Now, well open questions to the media. As you know, we need you to raise your hand on the Zoom. We also need you to indicate what your outlet is on the Zoom. We cant take a question from you unless we are very confident you are actually media. Having said that, weve got several questions already and the first goes to Belisa Godinho, from W Magazine, Portugal. Belisa, I know youve submitted two questions but please stick to one question, and I ask that of all journalists, one question at a time. So, Belisa, please go ahead.

BG Thank you. Thank you very much. The W Magazine media issue is about global health and climate. First, I would like to know specifically if and how will the virtual marathon for the design of vaccines on sustainability and the environment be implemented. Thank you.

00:15:25

MH Thank you, Belisa. Thats a very important question. Dr Soumya Swaminathan, our Chief Scientist, will answer.

SS Thank you for that question and, if I understand it correctly, youre asking about how do we prepare in the future for potential outbreaks that will arise, that we expect will come because of the close links between wild animals and the destruction of our forests and environmental hazards.

Weve seen the risk of pandemics continue to increase and spillover events as well. One of the things that we should be doing and we are doing is trying to anticipate where these risks can come from and identify mainly the viral families where we think that a spillover from animals to humans can happen and that can potentially result in epidemics or pandemics.

There are about 25 or so viral families where such a thing could happen. In the past, weve had the R&D Blueprint for Epidemics identify priority pathogens, one of which was a disease X, which SARS-CoV-2 turned out to be, and that was very helpful. The work that the R&D Blueprint has done over the last five years, since it was set up, helped us to prepare very quickly when we had the beginning of the SARS-CoV-2 and then we could move rapidly into developing the countermeasures.

Similar work now needs to be done and the other organisation thats involved in this is CEPI, which is the Coalition for Epidemic Preparedness Innovations, which is investing in platform technologies, mRNA but also other platforms, viral vectors and all the other new platforms that we have in order to prepare what are called prototype vaccines.

00:17:24

So, you pick one virus from a particular viral family and in fact this helped us because there were prototype vaccine candidates that had been developed for SARS-1 and for MERS and these could be quickly repurposed to SARS-2. Potentially, if you had these type or prototype vaccines that had been developed for different virus families you could, as soon as you had the new genetic sequence of the outbreak pathogen, could use that platform and switch over very quickly to a very specific vaccine.

That is the plan and WHOs role here is to develop this list of priority viral families, as I said, about 25, but also to identify priority pathogens or prototype pathogens against which vaccines can be developed. And Im sure that not just CEPI but many agencies and government agencies that have been set up now, like HERA in Europe, and BARDA and DARPA and the NIH in the US, and many others around the world will be investing in this and the whole idea is to be as prepared as possible against potential threats.

Were also seeing now, the DG just mentioned the number of outbreaks and the fact that we do not have tools against diseases like this Sudan Ebola virus even though weve had outbreaks in the past where we dont have enough stocks of cholera vaccines and so on. So, I think that this whole area of R&D, which is directed towards public health, is going to be increasingly important. Thank you.

00:19:02

MH Thank you very much, Dr Swaminathan. The next question goes to Carmen Paun, of Politico. Carmen, could you unmute yourself and ask your question.

CP Thank you so much for giving me the floor. Just on monkeypox, to my knowledge the countries that have been reporting monkeypox outbreaks for a long time still havent secured access to the vaccine and the therapeutic that is used against it. But I was wondering if you see any positive impact of this global outbreak on the countries that have been reporting cases for a long time. Is it increased awareness of the virus, is it more investment in research or so far there are only negative consequences? Thank you.

MH Thank you very much, Carmen. Dr Rosamund Lewis has joined us in the room just in time. Over to you, Dr Lewis. No, its not for you? Oh, sorry, Carmen, Dr Lewis was just coming in. Could you kindly repeat the question?

CP Sure. Very briefly, I was wondering whether she sees any potential positive impact of the global monkeypox outbreaks on the countries that have been reporting outbreaks for a long time. Does she see any increased investment in research? Obviously, theres more awareness. I was wondering if potentially, on the long-term, that could have any positive impact on the countries that have had to deal with the virus for a long time.

RL Thank you very much for that question. The countries in the African region are very much a part of the global response here, so we are working together with them, along with all other countries and all other regions. They are engaged in improving their surveillance. Theyre in engaged in improving detection. They have access to 38,000 test kits that have been provided to the countries for enhancing PCR and they are also engaged in trainings for clinical care and studies, studies on vaccines and studies on therapeutics.

00:21:14

So, we are very hopeful that this will increase the capacity throughout the region and also youve heard that the Strategic Preparedness and Response Plan is being released along with an appeal that we have, so that we can engage even further with the most affected countries. Thank you.

MH Thank you. Dr Briand will add some more on this issue.

SB Thanks a lot for this question. You highlighted this issue of access, inequitable access, and indeed this has been one of our main concerns at the start of this outbreak because there were products available but not everywhere in the world. So, WHO has been working very closely, first with countries who have already access to vaccines and will receive some donation of those vaccines.

We are working out a plan for allocating those vaccines but, of course, this is not an issue that can be dealt from one day to another because there are a number of things that we need to sort out, such as the regulatory aspect and the distribution of doses. We have also received donations from manufacturers and in particular for treatment, and so once those donation agreements are finalised we will be also in a position to allocate those life-saving interventions to countries with more difficulties to access those things.

00:22:50

So, its work in progress. Its not as fast as we would like it to be but its good lessons learned as well for everybody to see that when we have a disease that we didnt anticipate really enough in advance, that we may face outbreaks in multiple counties, we need to have in place a more global mechanism to ensure better access to life-saving intervention. Thank you.

MH Thank you very much, Dr Briand. I now have a written question from Helen Branswell, STAT magazine. Shes on a plane right now so cant actually ask her question on person. But her question is shes looking for an update on the vaccine studies, trials, where we are with assessing the vaccines for Ebola Sudan virus in Uganda. I understand Dr Abdi will answer this question first and then Dr Soumya will add as well.

AM Let me turn first to Soumya. I think weve been working very closely with Ana Maria and Soumya. Please.

SS I think, again, our R&D Blueprint team, led by Ana Maria Henao, has been working very, very closely with the Ugandan Ministry of Health but also with other partners, including CEPI and with the manufacturers. There are about six vaccine candidates available for the Sudan Ebola virus, which are mostly in very early stages of development, but three of them have some human data, some immunogenicity and safety data, and so they can actually proceed to be used in the field in a ring vaccination campaign, similar to what was done in the Ebola outbreak in DRC a couple of years ago.

00:24:55

Its a chimpanzee adenovirus. There are two different candidates, one from the University of Oxford and one from the Sabin Vaccine Institute. There are very limited doses available, unfortunately, of both of them. There is raw material, so there has to be some fill and finish to make the product ready and at the same time, of course, a protocol has already been developed, submitted to the Ethics Review Committee. The principal investigator has been identified, funding is being mobilised, and so all the preparations are ongoing.

Now, which vaccine, which of these two will actually go into the trial may depend on which one actually has doses to deployer sooner. It would be good, of course, to test as many vaccines as possible but at least start with one and then there may need to be a rolling intake. We are hoping that we could get this off the ground as quickly as possible but realistically it may take another four to six weeks and at the same time theres also a plan being made for testing of therapeutics.

As you know, there were several therapeutics tested again at the DRC during the last Ebola outbreak, one monoclonal antibody and remdesivir likely to be in a clinical trial that would test each one of them individually against a combination, but the protocol is still being developed and again were working with partners to do that. Thanks. Abdi, you wanted to add anything to that?

00:26:24

AM Just appreciation of the excellent work and collaboration with the R&D and here, in terms of the collaboration, we have a SAGE meeting on Thursday that will also discuss some of the plenary, and then the approval and the logistic support. Thanks.

MH Thank you both for those answers. Now, we have a question from Christiane Oelrich, from dpw. Christiane, please ask your question. dpa, I apologise.

CO Thank you, Margaret. My question is on corona. There has been some concern raised in Germany and other European countries about the sublineage BQ.1.1. I wonder what your take on this is. Thats basically it.

MH Thank you. I think Dr Maria Van Kerkhove is ready to answer that one.

MK Thanks very much for the question. As the DG said in his speech today, there are more than 300 sublineages of Omicron that were tracking right now and there are several that are on our radar. It sounds a little bit like an alphabet soup with all of these subvariants that were tracking but the bottom line is that this virus continues to evolve.

It's circulating at an incredibly intense level around the world right now. Among the Omicron sublineages, BA.5 is dominant. About 80% of the sequences that are available are BA.5 and its subvariant but surveillance has changed drastically in the last several months and the numbers of sequences that the world and our expert networks are evaluating has dropped by more than 90% since the start of the year.

That limits our ability to really track each of these and exactly the one that youve mentioned today. We have a number of subvariants of Omicron that are on our radar because what were looking at is we will continue to see waves of infection. This is for sure going into the future because we will be living with this virus but we have a lot of tools that can mitigate their impact.

00:28:25

We have diagnostics that can get patients into the clinical care pathway using antivirals and using different therapeutics to prevent severe disease, to prevent death. We have vaccines that continue to be effective against preventing severe disease and death. So, it is absolutely critical that we use these tools.

If we look at all countries and particularly in the Northern Hemisphere right now, we are starting to see an increase in case detection and in some countries were starting to see increases in hospitalisation, increases in admission to ICU and increases in deaths and this is really due to incomplete vaccination coverage, inappropriate or ineffective use of available tools like antivirals. Theyre being used among the populations that need access to them.

Were concerned and in the Northern Hemisphere were entering autumn and the winter months, so we will see co-circulation of other viruses like influenza, also mentioned by the DG today. So, we need health systems to be prepared. We need surveillance systems to be able to detect the known variants and subvariants that are circulating and we need to be able to detect new ones that are out there. But we need strong health systems to be able to deal with patients and provide appropriate clinical care regardless of where they show up within the health care system.

00:29:41

And if you hear anything, please ensure that you get vaccinated. In all countries we are missing people who are at high risk and the highest risk of developing severe disease, either because they have not received a single dose of vaccine or they havent received the full course of dosings that are recommended for them. So, please look at your national guidance, follow national guidance and receive the recommended doses in your area.

But the virus is circulating and theres much more that we need to do to reduce transmission while living our lives safely. Public health measures play a key role, wearing a mask when youre around others, when youre indoor improving ventilation, making sure we have good surveillance and we use the appropriate therapeutics, diagnostics and vaccines to save lives now.

MH Thank you very much, Dr Van Kerkhove. The next question goes to Megha, from Health Policy Watch. Megha, please unmute yourself and ask your question.

ME Thank you so much. My question is just could you please provide an update on what the status of work is at the mRNA hub in Africa? Thank you.

MH Dr Soumya Swaminathan will answer that question.

SS Thank you. Thank you very much for that question. Ill try to provide a brief update. As you know, the mRNA hub in South Africa is based at this company called Afrigen but there are a number of partners supporting, including the Ministry of Science and Innovation, as well as the Medical Research Council and then Biovac is the other company to which the transfer will take place.

00:31:19

At this point we actually have an mRNA vaccine candidate that has been developed by scientists in South Africa using publicly available information. Now this, because its a newly-developed vaccine, needs to go through all the phases of testing that a vaccine normally would.

Right now it is going to go into animal studies, hopefully this month, in October, for all the toxicity studies and so on, and then the technology transfer has to happen and then the GMP doses have to be produced so that it could then go into human clinical trials, which will likely start perhaps towards the end of 2023. And then theres a timeline for going into Phase 2 and 3 trials.

Meanwhile, of course, there is the technology transfer, which has also started happening since the basic methodology and the SOPs for how to develop a vaccine have already been done, even though its yet to be proven efficacious and safe. The spokes, and as you know, we have 15 spokes around the world in different regions of the world. Teams from those companies have already started coming to South Africa for training, for the technology transfer.

00:32:37

Theyre now taking that technology back into their own companies and their countries and beginning work, sometimes to use the technology for other products, for other vaccines. And different spokes are now having discussions about which other diseases they could target and theyre thinking about diseases like tuberculosis and malaria but also about chikungunya and dengue and other infectious diseases.

At the same time, there are two other workstreams which have started. One is the Biomanufacturing Training Initiative with the hub in South Korea. So, well have the second batch of trainees going there in October and were working closely with the WHO Academy team to really build a curriculum for manufacturing training in biologics.

Then, the other workstream is led by our regulatory colleagues, Dr Simo, Dr Rogrio Gaspar, and they are actually now building the regulatory capacity of countries because for countries to be successful producers and exporters of vaccines and health products you need a strong regulatory system. That work is also proceeding. So, all of these parallel activities.

We did start this with a longer-term view really, beyond COVID. So, the idea was not to come up necessarily with a vaccine for COVID, though that would be the proof of principle but its going to take time. So, the idea is to build this network, build the capacity, put the technology in the hands of scientists in these companies who will then make products that are needed for their own populations. Thanks. I hope that answered the question.

MH Thank you, Dr Swaminathan. Dr Maringela Simo would like to add a few points, as you mentioned, about the regulatory aspects. Dr Simo, please. Over to you.

00:34:27

MS Thank you. Thank you for the question. Actually, I want to share good news because this week we finalised the formal assessment of the South African Regulatory Authority, which is now considered by WHO as a functional Maturity Level 3 regulatory authority.

Let me say that the Government of South Africa has invested a lot of effort and training of personnel to be able to achieve WHO standards for a functional regulatory authority. Why is it important? Because South Africa hosting the hub, it needs a strong regulatory authority to oversee the production of vaccines in the country. So, I just wanted to share this news. Thank you.

MH Thank you, Dr Simo and Dr Swaminathan. The next question goes to somebody who has been waiting up very late at night, Mary Ann Benitez, in Hong Kong, from the Hong Kong Standard. Mary Ann, please unmute yourself and ask your question.

MB I would like to ask, because doctors and also the CHP Can you hear me?

MH Very well, Mary Ann. Please, go ahead.

MB Theyve been urging people to get COVID-19 and flu jabs in one go, warning of a possible seasonal, a double whammy of COVID and flu because there have been milder flu winter peaks in the past three years amid the pandemic. So, whats the WHO decision also? Is there a crystal ball that people should be overly worried of, as I said, a double whammy of flu and COVID at the same time? Thank you.

00:36:16

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WHO press conference on COVID-19, monkeypox and other global health issues - 5 October 2022 - who.int