WHO press conference on COVID-19, Ukraine and other global health issues - 4 May 2022

00:00:55

FC          Hello and welcome to WHO’s and today’s virtual press conference on COVID-19, the war in Ukraine, and other global health emergencies. We are Wednesday, 4 May. Simultaneous interpretation is provided in the six official UN languages, Arabic, Chinese, French, English, Spanish and Russian, plus Portuguese and Hindi.

Let me introduce to you, the participants in the room are Dr Tedros Adhanom Ghebreyesus, WHO Director-General, Dr Mike Ryan, Executive Director, Health Emergencies Programme, Dr Kate O’Brien, Director Immunisation, Vaccines and Biologicals, Dr Soumya Swaminathan, Chief Scientist, Dr Socé Fall, Assistant Director-General, Emergencies Response, and Dr Abdi Mahamud, who is the Incident Manager for COVID-19. And joining remotely is Dr Simão, who is joining us online. She is Assistant Director-General, Access to Medicines and Health Products. Now, without further delay, I would like to hand over to Dr Tedros for his opening remarks. DG, you have the floor.

00:02:20

TAG        Thank you. Thank you, Fadéla. Good morning, good afternoon and good evening. Globally, reported cases and deaths from COVID-19 are continuing to decline with reported weekly deaths at their lowest since March 2020.

But these trends, while welcome, don’t tell the full story. Driven by Omicron subvariants, we are seeing an increase in reported cases in the Americas and Africa. The South African scientists who identified Omicron late last year have now reported two more Omicron subvariants, BA.4 and BA.5, as the reason for a spike in cases in South Africa.

It’s too soon to know whether these new subvariants can cause more severe disease than other Omicron subvariants, but early data suggest vaccination remains protective against severe disease and death. The best way to protect people remains vaccination, alongside tried and tested public health and social measures. This is another sign that the pandemic is not done with us, and there are some clear takeaways.

First, vaccinating at least 70% of the population of every country, including 100% of the most at-risk groups, remains the best way to save lives, protect health systems and minimise cases of long COVID.

Availability of vaccines has improved significantly but a combination of lack of political commitment, operational capacity problems, financial constraints and hesitancy due to misinformation and disinformation is limiting demand for vaccines. We urge all countries to address these bottlenecks to provide protection to their populations.

00:04:30

Second, testing and sequencing remain absolutely critical. The BA.4 and BA.5 subvariants were identified because South Africa is still doing the vital genetic sequencing that many other countries have stopped doing. In many countries we’re essentially blind to how the virus is mutating. We don’t know what’s coming next.

Third, I am troubled that highly effective antivirals are still not accessible to people in low and middle-income countries. Low availability and high prices have led some countries to rule out buying these life-saving treatments.

ACT Accelerator partners are engaged in price negotiations to lower prices and increase availability. Coupled with low investment in early diagnosis, it is simply not acceptable that in the worst pandemic in a century, innovative treatments that can save lives are not reaching those that need them.

We’re playing with a fire that continues to burn us. Meanwhile, manufacturers are posting record profits. WHO supports fair reward for innovation but we cannot accept prices that make life-saving treatments available to the rich and out of reach for the poor. This is a moral failing.

00:06:12

In three weeks, leaders will come to Geneva for a critically important World Health Assembly. The theme will be Health for Peace and Peace for Health. With this in mind, tomorrow I will travel to Poland for the International Donors’ Conference for Ukraine.

The health challenges in Ukraine are worsening by the day, especially in the country’s east. WHO has now verified 186 attacks on healthcare in Ukraine. Scores of civilians were able to leave Mariupol yesterday and WHO and our partners were able to receive them and provide healthcare.

Humanitarian corridors like this are critical to get civilians to safety and health services to those in need. We urge the Russian Federation to allow people to leave Mariupol and other areas where civilians are at great risk, and we continue to call on the Russian Federation to end this war.

In the Horn of Africa and the Sahel, the climate crisis, spiking food prices and food shortages are threatening to cause famine and further insecurity. The Horn of Africa is experiencing its worst drought in 40 years. 15 million people are estimated to be severely food insecure in Ethiopia, Kenya and Somalia.

In Ethiopia, not enough food is reaching those who need it most. Since the declaration of the humanitarian truce in Tigray six weeks ago, just 172 trucks of aid were able to reach the region, representing just 4% of the need.

And, in Burkina Faso, repeated attacks on scarce water resources are depriving people of access to the minimum amount of water they need just to survive. Attacks on healthcare, sieges blocking food and medicine, attacks on water, each is an assault on the very foundation of life and, in each case, the only answer is peace.

00:08:37

Meanwhile, WHO is supporting vaccination efforts as part of the response to an Ebola outbreak in the Democratic Republic of the Congo. So far, 376 contacts have been identified, of which 243 have been vaccinated. No new cases or deaths have been reported in the last week, which is encouraging, but our teams remain vigilant.

As you can see, WHO is responding to a huge range of challenges around the world, to say nothing of our work outside of emergencies to strengthen health systems and promote the conditions in which people can live healthy lives.

All of this work costs money. Last week, a Member State Working Group agreed on a proposal for Member States to boost their annual assessed contributions to 50% of WHO’s core budget by 2028 to 2029. We welcome this proposal, which will be considered by the World Health Assembly later this month.

Finally, tomorrow is World Hand Hygiene Day and the International Day of the Midwife. To mark the day, WHO is launching the first Global Report on Infection Prevention and Control.

The simple act of cleaning hands can save lives, especially in healthcare facilities, where vulnerable patients can be exposed to infection. Out of every 100 patients in acute-care hospitals, seven patients in high-income countries and 15 patients in low and middle-income countries will acquire at least one healthcare-associated infection during their hospital stay.

00:10:38

WHO’s new report shows that where good hand hygiene and other cost-effective practices are followed, 70% of those infections can be prevented. For the first time, the report provides a global analysis of how infection prevention and control programmes are being implemented around the world. So, whether you work in a health facility or not, cleaning your hands regularly can be the difference between life and death for you and for others. Fadéla, back to you.

FC          Thank you so much, Dr Tedros. Let me now open the floor to questions from the media. To get into the queue to ask a question, you need to raise your hand using the Raise Your Hand icon and do not forget, please, to unmute yourself when it is time for you to speak. I would like now to invite the first reporter, Helen Branswell, from STAT. Helen, can you hear me?

HB         Yes. Thank you, Fadéla. My question is for Dr O’Brien. I’m wondering how WHO views annual boosters at this point in terms of COVID. Is the evidence pointing to a need for annual boosters? Do you know yet? Thank you.

MR         Hi, Helen. I think I’ll pass to someone who probably knows a lot more about this than me, Kate O’Brien, with us here. I think Kate is better positioned to answer that question.

KO         Thanks for the question. As you know, the recommendations from SAGE are around a full schedule, which includes the primary series doses and booster doses, and this is especially important for the variants that we have right now, Omicron variant in particular.

00:12:35

I think your question is about beyond having one booster following the primary immunisation schedule. What is our recommendation and where do we stand on additional booster doses? SAGE has reviewed the evidence on this. I want to emphasise that the evidence comes largely from a single platform of vaccines and we have four platforms of vaccines that are available. The first issue is that we are in a pretty limited space in terms of data.

The second is that the evidence comes from a limited number of settings and it does point to some benefit, short-term benefit of additional doses against some of the outcomes, in particular against hospitalisation. This is a really limited set of evidence that we have and we will continue to watch this evidence very carefully and come forward with recommendations about how to proceed with additional doses when there is sufficient evidence in that direction.

I think what SAGE has really focused on and will continue to focus on is the benefit and the protection, especially for the severe end of the spectrum and especially for those people who are at higher risk, and that’s really where we’re going to focus our attention and we’ll come forward as soon as we feel that the evidence is sufficient to make some statements around this. Thanks.

00:14:02

MR         Fadéla, I think Helen may have said O’Brien. Ryan and O’Brien are fairly close together in sound.

KO         Brother and sister.

MR         Brother and sister, so sorry, Helen, for mishearing you there. Your voice was fading in and out as you asked the question.

FC          Thank you. Dr Swaminathan, you have the floor.

SS          Just to add to what Kate has said, Helen. I think this also points to the need for more data. She mentioned that most of the data is on the mRNA vaccines. Most of the data is coming from high-income countries. We really need more data on vaccine effectiveness and the duration of that vaccine effectiveness in different populations with different kinds of exposure to the virus but also using different kind of vaccines, inactivated vaccines, viral vectored vaccines and so on.

So, again, a plea to countries to not stop surveillance. WHO has methodology that has been put out, standard methods for doing vaccine effectiveness studies that can be used, that can be implemented, and this will be useful also for studies of other vaccine-preventable disease.

Thinking about these integrated surveillance platforms and also ways of studying vaccine effectiveness in the population, I think that’s the only way to help answer these questions as to whether or not annual boosters will be needed.

00:15:24

The WHO also has the committee, two committees in fact, the TAG-VE which looks at the evolution of the virus and how significant that is in terms of its impact on disease outcomes, but also the TAG-CO-VAC that is looking at the composition of the vaccines and whether there is enough evidence to indicate that we may need a change in vaccine composition. Along with SAGE, these bodies are constantly updating themselves but they can only make decisions based on good data and so again a plea for more research.

And, of course, again a whole area of research that’s ongoing that we must continue to support is the new vaccines, especially the inhaled vaccines, mucosal vaccines, which could build up a different type of immunity that could perhaps be more effective at stopping infections and also the pan-coronavirus vaccines which would be for the long-term, I think, really worth investing in those platforms. Thanks, Fadéla.

FC          Thank you. Next question goes to Carmen Paun, from Politico. Carmen, can you hear me?

CP          Yes, Fadéla. Thank you so much for giving me the floor. A bit following up on the previous question. The leaders of the FDA wrote this week in JAMA that they think COVID vaccination will become seasonal, very much like the flu, and that there should be a decision probably by June about the composition of these vaccines that should be more tailored to respond to circulating variants. I just wanted to get the WHO’s view on that. Do you agree with that view? If so, what does this mean for the rest of the world, given where we are with COVID vaccination? Thank you.

00:17:12

FC          Dr O’Brien.

KO         I haven’t seen the piece in JAMA from the FDA but the issues that you’re describing are relevant, especially for where we are with vaccine coverage around the world. I think the first thing that we have to address is that identifying the need for booster doses, the frequency of booster doses, whether this is seasonal or non-seasonal, is all predicated on an environment where people have received their primary doses first and that is, first and foremost, what is most protective against COVID.

I think we have to recognise the remarkable progress that has been made on getting primary doses into those who are more vulnerable around the world. The supply is available for countries around the world to achieve the ambitions that they have for protection of the population, and the delivery really is advancing as rapidly as countries are able to stand up that delivery. But there’s still quite a ways to go in terms of achieving primary vaccination in every country around the world and, first and foremost, against the highest priority groups.

Just taking a look at healthcare workers and those over 60 as two of the highest priority groups, there is very good progress but we’re still at less than 50% primary coverage in some regions of the world for those priority groups. So, really, primary vaccination, those primary doses is what is essential at this point and the advancement and speeding of delivering those doses, especially to the highest priority groups, is the top priority.

00:19:03

The question of whether or not there will be then seasonal boosters, whether or not the composition of the vaccine should be modified to account for variations in the virus again, as Soumya described, we have expert committees that are addressing the composition of the vaccines, the TAG-CO-VAC.

I think the focus of that committee is very much on the performance of the existing vaccines against various outcomes and certainly we’ve seen that the performance of the existing vaccines against these variants is not strong against the infection, the mild end of the disease spectrum, and especially against infections that are asymptomatic and nevertheless are a part of transmission.

They will continue to work and look at the evidence and come out with advice on the composition of the vaccines, and I think that’s one of the really critical roles for WHO and for this committee, is that we have a coordinated view of what will make up the best composition of vaccines rather than having a dispersed set of decisions that will create quite a chaotic landscape of available of vaccines. Those, I think, are some of the issues that are being considered and I will be interested to see the piece from the FDA in JAMA that you referred to. Thank you.

00:20:32

MR         And just on the issue of seasonality. Viruses, when they first emerge in human populations tend to be very erratic in how they transmit and the epidemic curves that they create. Over time it settles into a pattern and the balance all the time is between the level of population protection.

How protected are the population from the virus? Are they vaccinated? Have they had a previous infection? How effective the vaccine is in reducing transmission, for example? And that’s always balanced against the efficiency of transmission and the efficiency of transmission right now, you can clearly see with the variants, BA.1, 2, 4, 5.

You’re seeing that increased efficiency of virus transmission but also the environment in which the virus is transmitting. In other words, are people indoors? Is it cold? Are people close together? All of these factors come together, the level of population protection, the efficiency of virus transmission, which is a factor of the virus, and then the conditions in which people are interacting and whether the virus transmission is promoted.

You can imagine, what we see with influenza viruses and others, that in those winter-type, colder conditions where you see people moving indoors, you see that influenza can take off in the Northern and Southern Hemisphere when people come inside and mix more and there’s more transmission.

However, in the middle part of the world, right across the tropics, there is no seasonal pattern in influenza. So, this perception that respiratory viruses ultimately settle into a seasonal pattern is not true. It depends where you are. It depends whether the population is vaccinated or not and it depends whether new variants are actually emerging.

00:22:11

There are a lot of factors that still need to play out for us to determine whether this virus is truly going to become a seasonal occurrence but what is true is if you’ve got low population protection, if people are crowded together in conditions where a new variant is spreading, you will see high levels of transmission, whether that’s in winter or summer.

I think the jury is still out as to how seasonal this virus will become but certainly we would expect in Northern and Southern Hemispheres, that in the context of relatively high protection, if the virus doesn’t continue to evolve tremendously in terms of its transmissibility, the virus will tend to transmit more at times when people are closer together because the virus is trying to survive, it’s trying to move from person to person.

It’s more efficient at doing that when people are closer together, when people are packed in, when ventilation is poor, it’s wintertime, you don’t open the windows. So, there’s a lot of factors that will drive transmission in winter conditions.

FC          Thank you. I would like now to Jules Coussement, from Tokyo Broadcast Service, to ask the next question. Jules, can you hear me?

JC           Yes. Hello. Can you hear me?

FC          Yes, very well. Go ahead, please.

00:23:31

JC           Thank you for taking my question. I just wanted to know if you had any update about the acute hepatitis case. Do you have any other information about new countries being concerned by that or any news about the disease origin? Thank you.

FC          Thanks so much. Jules, I believe we have our expert, Dr Abdi, who will take this question, but we have also Dr Philippa Easterbrook, who is joining us online. Dr Easterbrook, do you want to take this question and then we can supplement if any of my colleagues would like to add? Dr Easterbrook, you have the floor.

PE          Thank you. Well, since the first report from the UK on April 5, as of May 1, 2022 there are now at least 228 probably cases reported from 20 countries and there are above 50 that are now under investigation. We now have cases, therefore, reported from five WHO regions, the Eastern Mediterranean, the European, the Pan-America and SEARO, South-East Asian and Western Pacific region also.

But it’s important to highlight that only six of the countries are reporting more than five cases, and the other 14 countries are reporting less than five and, in some cases, just one or two cases. We still have reported one death and around 18 liver transplants that were performed.

In terms of an update on investigations as to the underlying cause, as we’ve emphasised before, we are looking at all possible infectious and non-infectious causes and I think what we can report is reinforcing some of the messages made last week that still apply in terms of what does not seem to be causing the acute hepatitis.

00:25:59

That is, again, that none of the common viruses that are associated with acute hepatitis, that’s A to E but also some other viruses, the glandular fever virus, cytomegalovirus, are associated. And that, from the detailed questionnaires of possible exposures, it still applies that there is no link to one geographic area or common exposure to particular foods or animals, travel or to toxins.

Then, again, to reiterate that the question about a link to COVID vaccines are not supported as still the majority of children, especially the younger age groups, had not received the vaccine.

I think everyone is aware of the possible link to adenovirus as one of the possible hypotheses based on a proportion of cases and most of the testing has been done in the UK, that 72 out of 84 tested were positive for adeno and that at the same time some of the countries had reported an uptick in their community transmission of adenovirus.

I think what considerable progress has been made over the last week has been with some special investigations, and these are a comprehensive set of in-depth studies to really complement what’s already known and to drill down a little bit more into the key hypotheses, particularly about whether adenovirus really is a cause of the hepatitis and not just an incidental finding.

00:27:48

These investigations, I’ll just briefly summarise, fall into three main groups and they’re very comprehensively described in the technical report from the UK, on the UKHSA website, page number 30. The three groups are investigations of the pathogen, looking in detail at the virus with detailed sequencing.

Then, secondly, looking at the children in more detail. We call these host studies, and that includes looking at the immune response in more detail and their genetics to see if this might explain why they’ve developed more severe disease.

Then, the third group, they’re called analytic studies and I think one of the most important ones here is a case control study that is comparing the rate of detection of adenovirus in the hospitalised children with liver disease with other groups of hospitalised children. This study is just starting, led by UKHSA, and results will be available soon.

I think the results of these investigations and others that are outlined in their report will be extremely helpful in informing other planned studies involving other countries, and we’ve already been meeting with a number of the key networks to plan ahead for these multi-country studies, once we have more information from the UK. Thank you.

FC          Thanks, Dr Easterbrook. I would like now to invite a journalist from Today News Africa who is not Simon Ateba, but Sarah Dwyer. Sarah, you have the floor.

SD          Thank you so much for taking my question. Can you hear me, all right?

00:29:37

FC          Very well. Go ahead, Sarah.

SD          Thank you. My question is to the Director-General. You said earlier that South Africa has identified two new subvariants of the Omicron variant. How transmissible are these and do the current vaccines work against them? Then, also, if you can comment on what you would like to see from President Biden’s summit on hunger coming this September, with all the hunger in the Horn of Africa, as was described earlier?

FC          Thank you, Sarah. I would like to invite Dr Abdi to take your first question.

AM         Thanks. As the Director-General has said, we really appreciate the excellent work by the South Africa scientists, both the epidemiological, the clinical and the laboratory for first discovering and sharing the detailed of Omicron BA.1 and also subsequently BA.4 and BA.5.

The good news so far is that they have done an excellent laboratory report, Aleks and I have shared that from here, all the result, timely result and then sharing that result. What they did in the initial preliminary report, they compared people who have been vaccinated and got the BA.1 and for those people who have not been vaccinated. The excellent result shows a good neutralisation for those who have been vaccinated and may or may not have gotten it. So, as the Director-General has said, the current vaccines that are available, as long as you are vaccinated, still the vaccines work and vaccines save lives.

00:31:13

We have also been reporting on other countries, not limited to South Africa. It’s only South Africa is looking for the virus, actively looking and then coordinating the data available. We know very well it’s just a matter of time before these variants replace each other as they try to compete. I just want to reiterate again the great work done by the South African scientists and the reassurance that the vaccines still work and still save lives.

FC          Thank you, Dr Abdi. Dr Ryan.

MR         The DG may speak to the specific issue of the summit but it’s fantastic to see global leaders really coming out now and addressing the issue of world hunger. We’ve continued to see, as the DG said in his speech, the impact on both water and food supplies of the multiple crises across the Sahel and the Horn of Africa, driven by conflict to a great extent, driven by climate change.

Increasingly, the remote effects of that, the war in Ukraine, is driving huge issues with food supplies. Elsewhere in the world, food prices are spiking. So, we have huge issues in the food markets, huge issues in food production, huge issues in food equity within countries, and it’s driving huge issues of ill health.

Hunger is a major risk factor for many, many other diseases, particularly for infectious diseases and outcomes in other important infectious diseases, particularly for children with underlying malnutrition and stunting, is very poor. Food and water, as the DG said, they’re the core of life.

00:32:58

Peace, food and water, these are things people have survived on for millennia. The absence of food, the absence of food at an affordable price that doesn’t impoverish, the presence of nutritious food that allows children to grow healthily.

So, it’s not just the amount of food, it’s the content in that food, it’s the price of that food. President Biden bringing the world together to address this is a very, very meaningful act at this very fragile time on our planet. I don’t know if the DG wants to supplement.

TAG        Thank you. Mike had, I think, covered it but I will just add a few points. One, as we speak, hunger is on the rise and last year’s estimate shows that 9.9% of the world population is affected and that’s really big, say 10%. People affected by famine, for instance if you take the extreme, it’s 45 million people. This is, again, end of last year’s estimate.

From the announcement, the Biden administration’s announcement to have this summit in September I think is timely because as you know eradicating or ending hunger is part of the SDG goals for 2030 and, as you also know, we are not on schedule. I mean we’re not track with regard to almost all SDGs, especially hunger.

00:34:52

And, as Mike said, the war now in Ukraine is further complicating the hunger situation, so you would have hunger more on the rise and risk of famine also we expect to increase. So, with regard to both SDGs and also the current acute problems we’re facing because of the war, I think the summit on hunger, nutrition and health that is planned by President Biden in September is timely.

As you may know, this is actually also the first since 1969 doing the same thing in the White House. Of course, it’s coming after 50 years but I hope this summit will be the reactivation of that summit but hopefully that will be maintained to achieve the SDG goals. So, we need to see it in relation to the SDG goals and the acute problems we’re seeing now due to the war. So, thank you, and Fadéla.

FC          Thank you, DG. I would like now to invite Shoko Koyama, from NHK, to ask the next question.

SK          Hello, Fadéla. Can you hear me?

FC          Very well. Go ahead, please.

SK          Thank you very much for taking my question. It’s a follow-up question on hepatitis. I understand the causes of the cases still remains very much under active investigation but what should the general public worry about at this stage? Thank you.

FC          Thank you, Shoko. Dr Easterbrook.

PE          Thank you. I think it’s important to emphasise that this is still a rare event and that stomach bugs and vomiting, diarrhoea occur not uncommonly in children and only a very small proportion would ever progress to this, as I said, rare event with liver failure and other complications.

00:37:29

I think it’s important for parents to be aware and that if their child has persistent symptoms or develops jaundice with yellow eyes and pale stools, to then certainly seek medical advice. In the meantime, until we fully understand the causes and the infectious agent, if indeed that is going to be the case, then basic principles of good hygiene and handwashing should apply, as they should for any gastroenteritis stomach upset. Thank you.

FC          Thank you. Dr Abdi would like to add information.

AM         Dr Easterbrook has covered the main thing, that basically tomorrow is Hygiene Day but also childhood vaccination, the chances of a lot of catching up and making sure all children are updated, and contacting your primary paediatrician is the first thing.

I think as the doctor said, we are still investigating. It’s a rare event but there’s a lot of intervention under the control of the parent that can do those inventions of making sure that the primary immunisation is updated, the primary hand hygiene, as that can prevent and save lives. Thank you.

00:38:50

FC          Thank you, Dr Abdi. Dr Swaminathan?

SS          Just a quick addition because there is some vaccine misinformation that is circulated around the association between COVID vaccines and hepatitis and I think, as Dr Easterbrook mentioned, the majority of the children who have been reported with this unusual hepatitis have not had a COVID vaccine, so at this point there doesn’t seem to be any relationship whatsoever. So, if things are circulating it’s more misinformation than based on facts. Thanks.

FC          Thank you so much, Dr Swaminathan. We are coming to the end of our press conference. We will be sending you the DG opening remarks and the audio file just after this press conference. Now, I would like to hand over to Dr Tedros for his closing remarks. DG, you have the floor.

TAG        Thank you. Thank you, Fadéla, and thank you to all members of the press for joining us today and see you next time.

00:39:52