WHO Director-General's opening remarks at the media briefing for Geneva-based journalists - 20 December 2021

00:00:00

TJ           Good evening. Good evening to this special press briefing from the Director General, Dr Tedros, for UN accredited journalists here, in Geneva. We are happy to see you back with us, so just a few words before I give the floor to Dr Tedros for his opening remarks. So, this is, as we said, an exclusive briefing just for you. And that is why we have said that there will be no live streaming, so you all have the opportunity to get something to report on first, without outside journalists following this briefing.

We will also make sure that people who are on the Zoom are only Palais [?] accredited journalists as well. There are a number of them who are, and we will also take some questions from them as well, alongside the questions here from the room. This will be recorded on both audio and visual, from our side. We may share this recording with other journalists than UN accredited journalists, but we will not do that immediately, so you will have exactly that time and that exclusivity that I was talking about for the briefing.

00:01:40

Today with us, besides Dr Tedros, is Dr Zsuzsanna Jakab, Deputy Director General, Dr Rogério Gaspar, who is Director of Pre-Qualification, Dr Samiar Asma, who is Assistant Director General on Data, and walking in is Dr Bruce Aylward, Special Advisor to Director General. We have a number of WHO officials online with us. I think Dr Mike Ryan is with us remotely and he will also be answering questions. We may have a few other officials online, depending on questions, who may jump in to assist with answering questions.

As for the format, this will be a one hour press conference, as we do usually, and we have a number of your colleagues who are online, please one question per person, so we can try to get as many questions as possible from as many of you as we can. With this, I will give the floor to Dr Tedros for his opening remarks. Dr Tedros.

TAG        Thank you, Tarik. For now, I will only say good afternoon. It is a pleasure to welcome our friends from the Palais back to WHO. The last time we hosted you in July last year, none of us could have imagined that almost 18 months later, we would still be in the grip of the pandemic. More than 3.3 million people have lost their lives to COVID-19 this year, more deaths than from HIV, malaria, and tuberculosis combined in 2020.

00:03:41

And still, COVID-19 continues to claim around 50,000 lives every week. That is not to mention the unreported deaths and the millions of excess deaths caused by disruptions to essential health services. Africa is now facing a steep wave of infections, driven largely by the Omicron variant. Just a month ago, Africa was reporting its lowest number of cases in 18 months. Last week, it reported the fourth highest number of cases in a single week so far.

There is now consistent evidence that Omicron is spreading significantly faster than the Delta variant. And it is more likely that people who have been vaccinated or have recovered from COVID-19 could be infected or reinfected. There can be no doubt that increased social mixing over the holiday period in many countries will lead to increased cases, overwhelmed health systems, and more deaths. All of us are sick of this pandemic. All of us want to spend time with friends and family. All of us want to get back to normal.

The fastest way to do this is for all of us, leaders and individuals, to make the difficult decisions that must be made to protect ourselves and others. In some cases, that will mean cancelling or delaying events, just as we have had to cancel the reception we plan to have with you today. But an event cancelled is better than a life cancelled. It is better to cancel now and celebrate later than to celebrate now and grieve later.

00:06:00

None of us want to be here again in 12 months’ time, talking about missed opportunities, continued inequity, or new variants. If we are to end the pandemic in the coming year, we must end inequity by ensuring 70% of the population of every country is vaccinated by the middle of next year. Last week, WHO issued emergency use listing for a ninth vaccine produced by the Serum Institute of India under licence from Novavax.

This new vaccine is part of the Covovax portfolio and we hope that it will play an important role in achieving our global vaccination targets. As you know, COVID-19 is far from the only emergency to which WHO has responded this year. In Afghanistan, Cox’s Bazar, DRC, Ethiopia, Syria, Yemen, and elsewhere, WHO is delivering humanitarian aid, supporting health systems, responding to outbreaks, and doing everything we can to save lives.

And around the world, WHO is working with countries to restore and sustain essential health services disrupted by the pandemic. According to new data released this year, 23 million children missed out on routine vaccines in 2020. The largest number in over a decade, increasing risks from preventable diseases like measles and polio. However, five countries were able to introduce to human papillomavirus vaccine to prevent cervical cancer, and a further nine are planning to introduce it over the next six months.

00:08:02

And in September, we launched a global roadmap to defeat meningitis by 2030. The pandemic has also caused setbacks in our efforts to defeat the world’s leading infectious diseases. There were an estimated 14 million more malaria cases and 47,000 more malaria deaths in 2020, compared to 2019. However, WHO certified two countries, China and El Salvador, as malaria free this year, and a further 25 are on track to end malaria transmission by 2025.

This year will also be remembered for WHO’s recommendation for broad use of the world’s first malaria vaccine, which could save tens of thousands of children’s lives every year. Services for noncommunicable diseases have also been hit hard. More than half of the countries surveyed between June and October this year reported disruptions to services for diabetes, cancer screening and treatment, and management of hypertension.

With 2021 marking the hundredth anniversary of the discovery of insulin, WHO added long acting insulin analogues and quality assured biosimilars to the essential medicines list, paving the way for increased access and lower prices, prices for these lifesaving tools. On tobacco use, we continue to see positive trends. Two years ago, only 32 countries were on track to lower tobacco use by 30% between 2010 and 2025. Now 60 countries are on course to achieve the target reduction.

On air pollution, we launched global air quality guidelines in September with clear evidence of the damage air pollution inflicts on human health at even lower concentrations than previously known. Just last week, more than 4,500 participants at the Global Conference on Health Promotion endorsed the Geneva Charter for Wellbeing, outlining key areas of action for driving a paradigm shift in disease prevention and health promotion, that if implemented, could reduce premature mortality by 50%.

00:10:57

And to mark International Migrants Day on Saturday, WHO has launched new standards to support countries to provide better health services to refugees and migrants. We have also taken several important steps this year to strengthen the global health architecture and WHO. We launched the WHO Hub for Pandemic and Epidemic Intelligence in Berlin. We broke ground on the WHO academy in Lyon. We established the WHO BioHub System.

Our open WHO online learning platform has now registered six million enrolments for courses on COVID-19 and many other health topics in 60 languages. Earlier this month, our member states agreed to negotiate a convention agreement or other international instrument on pandemic preparedness and response. And just last week, member states also discussed options for improving the sustainability and predictability of WHO’s funding.

We have also taken decisive steps to address instances of sexual exploitation and abuse, and to make sure that our people meet the high standards that we and our member states expect of them. 2022 must be the year we end the pandemic. But it must also be the year that all countries invest in preventing a future disaster on this scale and in accelerating efforts to achieve the sustainable development goals. That means investing in resilient telesystems, built on primary healthcare with universal health coverage as the goal.

00:13:08

Even before the pandemic, one billion people were spending more than 10% of their household budget on healthcare. When people can’t access the services they need or can’t afford them, individuals, families, communities, and entire societies are put at risks. In the year ahead, WHO is committed to doing everything in our power to end the pandemic and to beginning a new era in global health. An era, in which health is at the centre of every country’s development plans.

Let me end with some thanks. I thank the health workers all over the world who continue to put themselves in harm’s way to serve and save others. I thank the scientists, researchers, and public health experts who continue to develop new goals, new tools, against this virus and to study it. I think you, our friends in the media, for the role you play in covering WHO, helping to get our messages out and in holding us accountable. We very much appreciate those of you who have worked to cover WHO and the pandemic fairly and accurately.

Finally, I thank WHO staff all over the world who have continued to work in ways most people don’t see, to promote health, keep the world safe, and serve the vulnerable. I thank you. Tarik, back to you.

TJ           Many thanks, Dr Tedros. I already see a number of hands, so what we will do is we will take questions first from the room, but then we will also go to our Palais colleagues who are online, because many of them, for various reasons, were not able to join us. Just before we start with questions, just to repeat what we have said in the email, in the interest of all of us, we have to try to keep this event safe.

00:15:26

So, as we finish the press conference, we ask you to remain at your seat or at your place, while our speakers leave the room. And then after that, we will all leave the building together with colleagues from the media team. And also, as said, we really try to keep this exclusivity that you asked for and count on you that there will be no livestreaming. And we will make sure that people who are on the Zoom are only UN accredited journalists, in case some dial in numbers have been shared.

So, with this, let’s start. I see Christiana, Biram, and Gunilla. Let’s go in that order, and then we will go to the… Let’s take it one by one, first Christiana, and then Biram, then Gunilla, then we will go to our colleagues online. Christiana.

CH          Thank you, Tarik, for taking my question. It is directed to Dr Tedros. My question is about boosters. You argue continuously against booster programmes and you say there is no evidence that it helps against Omicron. And yet, eminent scientists in my own country, in Germany, in the host country of WHO, Switzerland, in the United States, say that is the way to go. Everyone should get boosters.

Are you not afraid to lose those governments and maybe even more, worryingly, the populations in those countries will just stop listening to WHO? Because this is just going totally against what they feel and think and are told is the right way to go. Thank you.

00:17:14

TJ           Thank you, Christiana. I see Dr Aylward would love to say something here first, and then we may go to others.

BA          Thanks, Christiana. I can take a first stab at that and then others may want to add. First, I think we have to be super clear, WHO has never said that it is against boosters and that there is no role for boosters. What WHO has said, very clearly, is that we want to make sure that every dose of vaccine used has the best possible impact to get us out of this pandemic. And what we are seeking is equity in the use of vaccines globally.

And the Director General has been extremely clear on this. As recently as last week, he made that point in one of the press conferences. But we’re in a situation, still, where, folks, you’ve seen the data, nearly 50% of the world is fully vaccinated, 50% of the world is not vaccinated. And what we are arguing is that the biggest bang for your buck, and I think it we go back to the experts in any country in the world, they’ll say the biggest bang for your buck is vaccinating someone at risk who has not received a dose of the vaccine.

And that is the point that the Director General and Who continue to make very, very clearly. At the same time, the Director General has said, and our scientific advisory groups have said, protection against the viruses, it does begin to wane with time. And with time, there will be a role for boosters. However, the goal right now is to ensure everyone gets their first doses. And remember, most of the people who are ending up in hospitals, in ICUs, even in Europe and in our countries, are unvaccinated members of the population.

00:17:20

So, this is an equity issue within countries, even in Europe, not only in countries around the world. So, we continue to look at the role of boosters. We’ve already said that there are certain groups for whom, at the highest risk, they do need to have an additional dose. But as we go forward, we still continue to make the point there are unvaccinated populations globally at very high risk, and even within the countries that represented them, where the expertise, Christiana, you referred to resides as well.

And I think when one properly explains what we’re trying to do here, in terms of vaccinate those who are unvaccinated, you don’t lose populations, you don’t lose leaders, you don’t lose governments. Everybody is very, very much aligned on that point, that you need to vaccinate the unvaccinated first. So, then you get to the people, you vaccinate them, and clearly, there’s increasing evidence that those most vulnerable will benefit from an additional dose. And we’ve got to get those regimens right as we go forward.

So, we are saying yes, there is a role, but we want to ensure the right folk are vaccinated in the right order. And remember, what we’re seeing, in some places, is not just a booster for those at highest risk, but a booster for everyone in the population. And again, that would make a real demand on vaccines in an environment where they simply are not available to everyone who needs them at this time.

00:20:32

TJ         Thank you, Dr Aylward. Just to let you know that we also have Dr Soumya Swaminathan online with us for any possible answers. Biram, the floor is yours.

BI         Thank you, Mr Tarik. First of all, I would like to thank you for giving us this great opportunity here after almost 18 months. My question is also for Mr Tedros. Mr Tedros, we have witnessed that you have been working intensely for almost two years from the beginning of the pandemic. And you and your team know this virus and pandemic more than anybody in the world.

So, can you give us an idea of best case, worst case scenarios for what the COVID situation could be in exactly one year from now? What decisions from WHO member states could lead to those two scenarios best case, worst case? Thank you so much.

TJ         Thank you, Biram. We had this question before. I will call on Dr Ryan, maybe, to come in here, unless someone else here from the table wants to start. Do we have Dr Ryan?

MR      Tarik, can you hear me?

TJ         Yes.

MR      Good afternoon to our Palais press corps. Sorry I can’t be with you today. I think it’s very difficult to talk in terms of predictions, but we can talk in terms of scenarios. There is no question that this virus is with us to stay for quite a while. We’ve been saying that for a very long time. The virus will continue to evolve. The virus will continue to cause epidemics in under protected populations and will continue to bring health systems under pressure where those health systems are weak or where we’ve got under vaccinated populations.

00:22:53

I think the danger in all of this is that we continue to not support our health systems. We continue to keep large proportions of the world’s population, particularly vulnerable people, in low income countries unvaccinated against the disease. We continue to drive the conditions in which new variants will emerge. And in effect, we’ve been saying it for more than a year now that we can end, and I think, Bruce, you’ve said this many, many times, to end the acute phase of the pandemic.

To end the death, to end the suffering, to end the hospitalisations through vaccinating the most vulnerable people. Those with underlying conditions, those older persons, people who will get the lifesaving benefit of these vaccines. So, yes, we have a number of scenarios, depending on what governments do, but governments need to continue to try and suppress infection. They need to continue supporting communities and reducing the risk of disease spread.

They need to ensure that vulnerable, older persons, health workers, are fully vaccinated. And if we can do that, then what we can, as the Director General has said many, many times, we can end the acute phase of the pandemic by ending the hospitalisations, the suffering, and the death, and the pressure that has brought our health systems to the point of collapse once again.

00:24:18

TJ         Thank you, Dr Ryan. I think Dr Tedros would like to add something.

TAG     Thank you. I think both wanted me to say something. vielen dank for the question. I will comment on both of them, they have already been addressed, but just a few things to add. On the boosters, as Bruce said, WHO is not against boosters. What we said was, at that time when I put the moratorium, it can be used immunocompromised persons, because there was evidence that it could help.

But on other groups, we need to get evidence before we started. There was, at that time, as you said, as Bruce said, and also, it will be the case in the future, we need to always put the equity issue into that factor. Because unless we try to vaccinate the unvaccinated, especially that we are missing because of equity problems, we may not get the desired outcome. It’s not just about booster issues. For instance, some countries are doing boosters very aggressively, while their hospitals are filled with people who are not vaccinated.

Many studies show that 80% of the hospitalised people are actually unvaccinated. So, the best would be for countries to hand those who are not vaccinated, head count, convince them to be vaccinated, and make sure that they are safe. Because even the two doses reduces severity and also, death. So, their energy should be spent on finding the unprotected and protect. Because the evidence is also showing that more than 80% of hospitalisations in many counties is because they are unvaccinated.

00:26:44

It’s not because they are not boosted. That’s the reality. So, I think they should focus on something that should be focused on, that’s the issue. We had a meeting today and in the last few days. There is new evidence emerging now of its benefits, especially with elderly groups, senior citizens, especially above 65 and above 60. So, if it’s going to be used, it’s better to focus on those groups who have the risk of severe disease and death, rather than, as we see, some countries are using to give boosters to children, which is not right.

Then the equity issues comes in here. Instead of boosting a child in high income countries, it’s better to vaccinate the elderly in countries where the elders have not been vaccinated, even the primary vaccines. So, the equity issue should also come into play. I think this is the first one. The second on the prediction. It’s very difficult to predict, as you know. And we are facing another very hard winter. But we also believe that we can get through this with solidarity.

The first question can address the problem and we can open up. For the world it can be better with better equity and also, solidarity. As my colleagues said, as Mike said, we have the tools and knowledge, and it’s a matter of implementing them. So, what happens in the future, whether in 2020 or beyond, is on how best we are using the tools we have at hand. Not only vaccines, but all the tools that we have at hand. If we do that, I think we can be better off. That’s what I would say.

00:28:40

So, let’s do the vaccines, let’s do, also, all the public health measures, and we can be in a better condition because we know the virus better now and we have better tools. We know the virus better and we have better tools. It’s a matter of implementing properly. So, thank you so much. I have many colleagues here, and what we do always, I think it’s better if we share your questions, that’s why I was a bit quiet. But since you are in our room now, maybe you needed to hear my voice.

TJ         Thank you, Dr Tedros. Dr Swaminathan would like to add something here. Dr Swaminathan.

SS          Thank you. I just wanted to add about the research and development that’s going on, and that’s still going to be needed, because of all the challenges we are facing today. We certainly need more vaccines. Vaccines that are better able to protect against infection, not just against disease. We need even better diagnostics, more affordable diagnostics. We know that the lack of diagnostics in many parts of the world is a huge challenge, just as the lack of vaccines is. So, we are encouraging the research and development in this area to continue. As you know we have the Solidarity Therapeutics trial that tested four drugs in the first phase. These were repurposed drugs like Hydroxychloroquine, Lopinavir/Ritonavir, Remdesivir, and so on for the impact on mortality.

And in the next phase of the Solidarity trial we’re testing three other repurposed drugs which have anti-inflammatory effect to be used in the later stages of the Covid infection, when it causes the lung damage, and the ARDS like syndrome. Similarly we now have a Solidarity vaccine trial platform that is capable of testing a number of different vaccine candidates.

00:30:51

As you know, there are many candidates still in development in phase one and phase two. In fact dozens of them. Some of them are nasal vaccines, some of them are even oral vaccines. And using some novel mechanisms, novel platforms. And so it’s possible in the future that we will have vaccine combinations which can provide both nasal immunity, mucosal immunity, which is much more effective in preventing against infection. As well as systemic immunity.

Also the search for better antiviral drugs. Having oral antivirals like what we have now from Pfizer and Merck. And having more options to treat the viral infection early on. All of these are also things which can make a big difference to the outcome of the pandemic. Thank you.

TJ           Thank you Dr Swaminathan. Next question, I think we have here Gunilla von Hall from Svenska.

GH         Yes, hi. [Non-English] Sweden. Dr Tedros, you talked about the fight against future pandemics. What we’re seeing right now, is this a rehearsal for future pandemics? And how would you characterise the way countries are prepared, judging from these two years, for future pandemics? In this context also, how much of a problem is it that we have not yet found the origin of the virus? Can this be done, and what do you expect concretely from China in the way of collaboration to find the origin of the virus? Thank you.

TJ           Thank you, Gunilla. As Dr Ryan was involved in both of these topics, maybe we can start with Dr Ryan.

MR         Thanks, Tarik. I don’t know if Tedros wants to take the [unclear], he wanted to speak more simply when it was face to face with our colleagues. But I can begin. Certainly, I hope this is not a dress rehearsal for the next pandemic, because we wouldn’t get top marks collectively around the world for the preparations that were made for this one.

00:33:12

I think we have developed systems that are very static. Systems that could count things, count beds, count labs, count people. But a system that was quite inflexible, incapable of scaling up quickly. Very rigid. Not agile enough to deal with the realities that were evolving over time in this pandemic.

Tremendous number of brave workers at all levels, and not just health workers, scientists, frontline workers, a huge effort by communities. We’ve seen some wonderful acts of community resilience, and community solidarity. We’ve also seen a huge growth in distrust between communities and government. A huge explosion of misinformation. An infodemic that’s overwhelmed people.

So, there are a lot of things coming out of this pandemic in terms of our ability to do good surveillance, testing, contact tracing. Our ability to vaccinate. Our ability to rules and scale of workforce and move that workforce around. Our ability to do research and innovation in real time. And yes, we’ve had some wonderful innovation around vaccines. But we’ve also had real difficulties in scaling some technologies and more importantly in sharing those technologies.

00:34:33

So, when you look across, we’ve had huge issues with health medical supply and logistics chains. A lot of problems there with hoarding, and privacy and many other things. So, on the public private side of things in terms of partnership, I certainly think that needs to improve hugely if we were to face the next pandemic.

So we have problems, both in terms of the animal-human interface and detecting and reducing the risk of these diseases happening. We have huge problems for amplification of disease within our communities, within hospitals, within populations that are overcrowded and living in terrible, terrible conditions. And we have issues with diseases being able to propagate and move quickly around the world.

So in terms of emergence, amplification, and dissemination, we have real challenges ahead. However, we have seen, as I said, great advances in technology. Huge courage by frontline workers and communities. So, we have the ingredients to change the future. And we have the… If we have the will to do that.

And Dr Tedros and the Member States have led a process towards a new international treaty or convention that may help us to put together a framework that prepares us for a better future. Certainly, our kids want to see that.

But social inequity, social injustice, climate stress, and the threat of pandemics have intertwined now, and no longer can they be separated. We will have to deal with becoming a fairer world if we’re going to become a safer world.

00:36:14

With regards to the origins, it is important for us to try and understand the origins of the disease. It’s not absolutely essential, but if we want to reduce the risk of the species barrier being breached again, then you need to know where the walls were breached. And at this stage we don’t know. We don’t know for sure how that happened. So, knowing that would be very important for long term risk mitigation, risk reduction measures.

We continue to work with all countries. We are making good progress in the Scientific Advisory Group for Origins. We very much thank the members of that group. They’re engaged very intensively now in reviewing all of the scientific work that’s been done over the last two years. And colleagues from China continue to engage with that group. Including colleagues from scientific institutions from all over the world.

But we do need to make progress there, and we would rather make faster progress than we’re necessarily making at the moment. But we will continue as a secretariat to create the platforms and create and maintain the dialogue that’s needed in order for us to better understand the origins of this disease. Because, mark my words, it will be important to understand, if we can, the origin of SARS-CoV-2.

00:37:31

But for things like Ebola and things like HIV, and other diseases, as far as even the original SARS, it took a very long time to even begin to understand the disease origins. This is not an easy task.

TJ           Thank you Dr Ryan. Dr Tedros?

TAG        Yes, thank you. I just would like to add a bit. I think, are we ready for the future? I think that the question is simple. Still not ready. But as Mike said, are we doing something towards helping us to prepare for the future? I think we are. And things are being done differently. And I hope that will sum up.

But we need to implement the recommendations from the panel and others. Learning really from this pandemic. And preparing, to prepare for the future.

Will it be possible to prepare for the future, and will we be able to implement the recommendations? I think we can. That’s what I feel, or I believe. And we can be better prepared because I think we’re developing muscle memory. This is a very serious pandemic. And each and every country is learning from it.

And hopefully a situation like what happened during this pandemic in Mekong region can happen. As you know, with SARS the experience in the Mekong region was very, very serious. And when this pandemic hit, they did much better than the rest of the world. Because they had that trauma, this experience from SARS.

I think the whole world had already learned that. And we hope that muscle memory can help. But at the same time, we have to put all that we have learned together and implement them.

00:39:38

And one is that can help us to implement some of what we learned as a pack, is having a treaty. And what we call it, Generational Agreement. As Mike said, that is going to be very important for our children and grandchildren.

Many of the failures during this pandemic happened because we didn’t have rules for many of the things. We didn’t have rule of a game. And meaning, no obligation from many countries. And countries were doing whatever they want. Starting from burning PPEs, burning vaccines, and you see the vaccine inequity now you face.

So, we hope the treaty can address many of the global problems we have seen. But at the same time, we’ll go back to what I said earlier, if there is going to be good preparedness, it depends on the preparedness at the country level. And the muscle memory that I have said. So, we need to prepare both at country level and also global level.

But from what I see, and the experience of the Mekong region from the muscle memory, I hope the world will really have enough to learn its lessons and respond better for any next one.

But that, I think being said, we have to focus now on ending this pandemic. And our readiness for the future one will depend on how better we respond and stop this pandemic. And it starts from vaccine equity, as I said earlier. And also the other issues.

00:41:34

On the origin study, I think Mike had already said on that. We’re institutionalising it. It’ll not just be for this, but for other diseases as well. And we have already selected senior scientists, and they have already started working. Of course it takes time, origin study. You know about MERS and the first SARS. This also may take time, but we need to continue until we know the origins. We need to push harder. Because we should learn from what happened this time in order to get better in the future.

And I hope some of the challenges we have faced with regard to the origin study, especially in sharing information, information sharing data from China’s side will improve. Because it will help. Without transparency and sharing of data, I don’t think the origins could reach a successful conclusion. So, we’re hoping that this time they will cooperate better. And second, all options should also be open. That kind of openness is very important.

By the way, it’s science, nothing else. You don’t exclude any option until you’re convinced beyond reasonable doubt. So, the two are very important going forward. Because from the previous report, these two were the missing elements, central, very important. And which needs more transparency, and more openness. And we hope there will be better cooperation this time. Thank you.

TJ           Thank you Dr Tedros. We will go now to our colleagues who are online. Our [unclear] colleagues. So, we’ll start with Eliza Isakova from RIA Novosti. Eliza, please unmute yourself.

EI           Yes, hi, thanks for taking my question. And thanks for this opportunity to ask questions in person. However, I’m online. It’s a double question actually on Russian vaccines, and a follow up on Christian’s question.

00:44:15

So, my first question is about Sputnik, and other Russian vector vaccine. I know that both are now reviewed by the WHO. So, I would like to know exactly what are the timeline for Sputnik? Because I heard that Russia should submit papers by the end of December. Is it correct to say that the examination of Sputnik will be done in January?

And on vector vaccine, just to follow up to know, maybe it’s a question to Soumya Swaminathan to know what the updates are, because the latest was on January 15^th.

And a follow up for Christian’s question about booster doses. Do you consider now that booster shots should be done every six months? Thank you.

TJ           Thank you Eliza. Let’s try really to keep it to one question per person. There is a number of colleagues from [unclear] online wanting to ask question here in the room as well. Dr Rogério Gaspar may start on a status of EUL for particular products.

RG         Yes, thank you. So, concerning the Sputnik V, the timelines are as follows, so the process was restarted. And we have now two deadlines for submission of documents. So, part of the package will be submitted by 30 of December, and the final part of the package will be submitted by the end of January. So we hope that the applicant will conclude the submission of the application by the end of January.

00:46:03

But at the same time, as we are receiving more information, and what is now promised is to submit the quality package, and the manufacturing package by the end of December. We are starting already for the planning exercise for the forthcoming GMP inspections that will be necessary, looking at the new data to be submitted.

So our planning right now, provided that all information is on board, and with the adequate information being answered by the end of December. We would be able to perform GMP inspections locally on Sputnik in February.

Concerning vector, there’s no further information. So, there was a first interaction but no follow up on that one.

TJ           Thank you very much Dr Gaspar. Is there anyone who would like to take question on time between primary doses and boosters? Maybe Dr Swaminathan, if Swaminathan is online.

SS          Yes, I can address that question. I think everybody wants to know about the boosters. When it’s needed, how often it’s going to be needed, and so on. The fact is that we don’t know because there are many factors which can influence this. One is the type of vaccine. We know that each vaccine has a slightly different performance, and longer follow up is telling us about the efficacy of these vaccines, particularly in preventing severe disease, but also in preventing infection.

The other big variable of course is the variants of the virus that we’re seeing. And we’ve seen that different variants have different ability to be neutralised by the antibodies or be able to overcome the immune response. Like Omicron seems to be doing because of the mutations it has. It seems to be pretty good at evading the immune responses.

00:48:05

The current factor, of course, is the biology of the individual, the age of the person. How strong the immune system is, whether there are other underlying illnesses which impact the immune system. And therefore when we make recommendations for a course of vaccination we have to take into consideration all of these factors.

And so that is why SAGE has been following the evidence very closely. There is some data now to show that there is a slippage in the protection due to the different vaccines at about six months or so. Particularly for protection from infection, less so for protection from disease. They are still performing at over 80%.

But with Omicron, again, the initial data coming in obviously is showing that Omicron is very successfully able to evade immune responses, and therefore needs higher levels of antibodies. Again, we do measure T cell immunity regularly, lab assays, and so we know it plays an important role.

For now we believe that boosters may be needed for people who have weaker immune systems, the older individuals, the more vulnerable people. And whether a third dose of the vaccine is going to be it, or whether there’s going to be need for additional vaccines, like Influenza every year, every couple of years. It’s too early to say, and we need to really follow the science on that. Thanks.

00:49:37

TJ           Thank you Dr Swaminathan. With us is also Dr Abdi Mahmoud who is the Incident Manager for Incident Management Support Team. And he’s closely following the Omicron variant. So, Dr Mahmoud, would you like to add something at this point?

AM         Thanks Tarik, and Dr Soumya has covered, but I just, for the interest of this session, I just wanted to explain some basic immunology. Because when the media reports, it’s lost in the context. Basically, when we have an infection we produce what we call two type of cells. We have the cell mediated and then the immunoglobin.

So the body is very economic, just like us. The immunoglobin goes down, and when we receive a booster it goes up again. So when we report some of this neutralisation reduced, it has to be looked at very carefully on what is the T cell’s levels. Because when all the vaccines were being licensed, were licensed to protect against disease. And so far the preliminary analysis from South Africa, from the UK has remained intact. That it’s still protecting against severe disease. And that’s what they were licensed for.

Of course the mRNA vaccines were better adapted to prevent infection, some of them. So, I think the good line is, although we are seeing a reduction in the neutralisation antibodies, almost all the preliminary analysis is showing that the T cell mediated immunity remains intact. And that’s what we really require.

00:51:15

Of course if we change, and some other immunology, some people may not have a good T cell response that prevent them from diseases. So I just wanted to put in that context, when we talk about immune, immune is a complex system. What we are seeing right now from all indication is the reduction in the humoral, that’s antibody mediated, and not the T cells. Thank you.

TJ           Thank you Dr Mahmoud. We’ll go to next question. Stefan Busagh [?] from Luton [?].

SB          Thank you so much, Tarik. Thank you very much for holding this briefing. My question, there are recent studies that say basically that there’s only vaccines, the MR [?] and messenger technology. So, Pfizer and Moderna. Which provides a certain efficacy against the Omicron variant.

But on the other hand, the other vaccines, whether they’re Chinese or AstraZeneca, or CoviShield, which have been used a lot in India, in Africa, and things like that, are not giving any protection against the Omicron variant. What can you say about this tremendous challenge coming up? Thank you.

SS          Tarik, maybe I can start?

TJ           Please. Dr Swaminathan, please.

00:52:41

SS          Thank you. There’s understandable huge amount of interest and concern on whether the available vaccines that are being used around the world are protecting against Omicron. There was similar concern for the Delta VoC if you remember. And studies showed that while there is a reduction in the neutralising activity in the lab against the Delta variant. In actual fact, in real world, all the vaccines continue to do pretty well against severe disease and hospitalisation.

So, this is why we have to be very careful in not over interpreting the data from the neutralisation assays. Which is what we are seeing a lot of now. A lot of studies coming out against all of these different vaccines you mentioned. Showing that Omicron does… The neutralising activity of antibodies is much less for Omicron, and there are several fold reductions in the neutralising activity.

This gives us a hint, of course, that… And even from the mutations from the sequencing, and the type of mutations we could have guessed. And that’s exactly what was being shown.

But as Dr Abdi was also just saying, there are other aspects to the immune system that are not measured by neutralising activity alone. And those elements of the immune system probably are playing a more important role in protecting against severe disease. While antibodies seem to be quite correlated with infection.

Again, you have mucosal immunity, which is probably more likely to be better generated through intranasal vaccines than the currently used intramuscular vaccines. So, it would be premature, in my view, to jump to the conclusion that all vaccines are failing to act against Omicron except the mRNA vaccines. I don’t thing that we’re in a position to say that. In fact, it would be quite risky to conclude that.

00:54:51

Of course we are following the data very closely. We’re following the science very closely. We do not believe that all vaccines will become completely ineffective against any variant. Yes, you can have different levels of efficacy. But it’s unlikely that you would have a complete loss of efficacy.

We did have an R&D blueprint consultation on this topic last week. And there were many studies that showed the effect on the neutralising antibody activity was quite marked. On the other hand, the epitopes, or the antigens of the virus that stimulate the T cells have been more or less preserved, even with the Omicron variant.

So, I think that what we need is better data. We need more studies from more countries looking at vaccines beyond mRNA and AstraZeneca. Those seem to be the only vaccines for which we have some data from clinical studies. And we should be able to update you in a couple of weeks. But it does take a little bit of time to collect the clinical effectiveness data. So we need to be a bit patient. And it would be very dangerous to jump to the conclusion that the vaccines are not working. Thank you.

TJ           Thank you. Dr Aylward.

00:56:06

BA          Thanks Tarik. And thanks Stefan because it’s a really important question you ask. I think we’ve got to be really careful, like Dr Swaminathan was highlighting, in differentiating an absence of information from an absence of effect, right.

If you look at the data around the mRNA vaccines, we’ve got data now, I think there’s about 15 studies that are suggesting what’s happening or looking at what’s happening with neutralising antibodies. When you look at the AstraZeneca, I think there’s two studies maybe. And then with the other inactivated products, one. So, we just have not got the same amount of information across the different products.

And we had, as Dr Swaminathan highlighted, almost the same conversation. It’s interesting, every time we have a variant we have almost the same conversations. We had, oh, this is the way it is. And then we get more information. Actually it doesn’t quite look like that. And we’re a little bit in the same situation with Omicron now. It’s just early days with not a lot of information.

And when we look at it based on how the… What the virus looks like, what part of the virus is actually targeted by the products, etcetera. There should still be substantive effect by the other products. That needs to be your ingoing assumption.

The other really important thing to remember, everyone, is that most of those hundreds of thousands of cases that are being reported regularly still now are Delta cases as well that are occurring around the world. So we need to use all of the products that we have as aggressively as we can to try and control as much of this disease, and the variants that are circulating as possible. So anything that dents the confidence in those is really going to just set us back. Thanks, Tarik.

00:57:59

TJ           Thank you Dr Aylward. Let’s go to next question. Isabelle Sako [?] from FA Online. Isabelle.

IS           Good afternoon. Thank you very much for this briefing. It’s really helpful. I would like to know from what you are seeing around the globe, how do you think Omicron variant will change the evolution of the pandemic in the next month?

TJ           Thank you, Isabelle. So, the question is, how the Omicron variant will change the evolution of the pandemic in the next month. Anyone would like to venture there?

MR         Tarik, this is Mike.

TJ           Mike, please.

MR         Yes. Possibly [unclear] we want to sum it. I think Dr Tedros spoke to this earlier, as I did. Certainly, we’ve been tracking variants of interest, and variants of concern through the Virus Evolution Working Group. And now what has evolved into the Technical Advisory Group on Virus Evolution. So this was expected. We expected this virus to evolve. Especially when it’s at pandemic levels, passing through millions of people. These viruses change over time, and they change every time they pass between one human to another.

00:59:31

And we’ve certainly given this virus every opportunity to evolve. So from that perspective we continue to expect to see an evolution of the virus. We would prefer if we’re not giving the virus maximum opportunity to evolve. And as Dr Tedros has said, to focus vaccination on those who will suffer most if they’re infected. I think we expect to see this virus enter a phase of transmission where it will be around for a long time, probably at lower levels with seasonal or intercurrent outbreaks that will occur from time to time in populations, particularly as the new variants can emerge.

So I think we're still on that virus roller-coaster right now and the decisions we make in the coming months will have a big impact on where the virus goes. I think, as Dr Samira [?] said, the development of second and third-generation vaccines, the further development of antimicrobials, the integration of testing, much more broad, widespread testing into our surveillance and response, all of these things can help.

So innovation and technology will help in the next year and if we can keep the virus transmission reduced to a minimum and if we can vaccinate more and more people then we may be able to bring this pandemic to an end. Certainly we can bring the acute phase of death and hospitalisation to an end.

There's no question there but as we have said and Dr Tedros has said for many, many months, we will have to learn to live with this virus, as we do with previous pandemic viruses. This is not unusual. In fact one of the most common - the most common circulating strain of influenza virus is the influenza that caused the pandemic in 2009.

01:01:33

It's a fact of life that pandemic viruses continue to transmit in all pandemics for many, many years and as populations gain immunity, as populations become vaccinated then the virus settles into a pattern that's less disruptive and that we can cope with and we would hope we would consign this disease to the category of a relatively mild disease that's easily prevented, that's easily treated in well-functioning health systems that have good infection prevention and control and prevent the disease amplifying in those settings and that we're able to cope easily with this disease into the future.

That should be what we do with any disease. It doesn't matter what it is, tuberculosis, malaria, Ebola. We have lived with infectious diseases as human beings forever. It is not about getting rid of...

There are very few diseases that you can actually get rid of. We've only ever done it once, with smallpox. We hope to be able to do it with polio but those diseases were diseases that were exclusive to humans, they didn't have the complication of having animal hosts that the disease could pass to and then pass back.

01:02:46

So the chances of eradicating a SARS coronavirus are very limited. Learning to live with, cope with, react to and consign the disease to something that we can easily deal with day-to-day is what we should be hoping and aiming for.

TJ           Thank you. Dr Aylward.

BA          Thanks, Tarik. I just wanted to come in, Isabel. It's an excellent question about how omicron should be changing the evolution of the pandemic. Mike spoke a little bit to that but it really comes back a bit to the question, Gunila, that you asked earlier, how does it change the evolution of our response really?

So here we are, 24 months into this crisis. We have a new variant and we still have huge parts of the world where we can't actually see and we don't know if that variant is possible so we still have huge gaps in our surveillance infrastructure.

So this should be wake-up call that, hang on, 18, 24 months into this you still have these huge gaps so here we are also 18, 24 months into this and we're unable to pivot back to those basics of test...

01:03:55

I remember... Director-General, I thought you would have come in and said test, test, test. Someone asked earlier how we could be changing this but we should be testing, we should be isolating and we cannot pivot to those basic public health measures and we need to do that, especially if there's question about immune escape on the product.

Here we are again 12 months into proven, effective vaccines and some of the most important ones, the MRNA vaccines, as we talked about, very limited production sites around the world. Is this any way to really be fighting a pandemic, where you've got two or three production sites for two of the key products that you're using?

This comes back to the Director-General's call for more expanded production sites including if necessary waivers on the technology. Every time you have an issue like this... You've all raised the issue of the MRNAs and the importance of these but still we're relying on very few places.

So we've not seen that shift that you would expect in how you're going to tackle this and most importantly - Mike highlighted this earlier - you've still got legions of healthcare workers around the world who are not protected with the most basic personal protective equipment.

01:05:13

So yes, omicron does have implications, changes the evolution of the pandemic but it really should be changing - we should be seeing the change in our response now. We have all the tools we need to be able to tackle this thing going forward. In fact I think Martin [?] asked the question early on of best and worst-case scenarios.

It depends completely on to how we listen to the virus and actually use the knowledge, the tools, the production capacities we have and the production capacities we're not using around the world to tackle this thing. There's a lot of under-utilised talent that could still be expanding our production, expanding availability of these key products.

TJ           Thank you very much, Dr Aylward. We are over the hour but I think we can take two more questions, if possible from journalists that we don't often hear in our press briefing so I would give the floor to Tomo from Kyoto and then to Katrin and with those two questions we will wrap up today's press briefing. Tomo.

01:06:17

TO          Thank you, Tarik. Director-General, I understand this is not yet the topic that you want to go into detail on but the Director-General's election is coming up in May. Since you're the only standing candidate so far could you tell us about your view on how you would like to make WHO a more effective and more powerful organisation to control the pandemic? Thank you.

TAG        I will tell you a story. A colleague called me and said, Tedros, you're unopposed. Then I said, pardon me? You don't have any challenge, you're the only candidate. Then I said, yes. Then this friend said, that's boring. Then I said, it's not boring for me!

Then I said, why boring, why are you saying boring, what do you want? He said, if there was competition then we would have seen the punches in the competition, which would be good entertainment for us. I think he was denied that entertainment. That's why he's calling it boring.

Anyway, my appreciation to all the member states who have nominated me. This is the first time actually that 28 countries nominate one person. It shows the confidence they have and I'm very, very grateful for that.

01:08:05

In addition to those who have nominated there is a lot of support also coming from member states, which again makes me take things seriously because when expectation is high it's not easy.

Then on the future, of course especially when you're focusing on emergencies, we have excellent recommendations from IPPR, from IHR, from IOAC. These were established based on the resolution from the assembly but even other assessments beyond what was done through WHO but from other entities also.

So what we have done is we're pooling all these recommendations and we will implement, I think, a good part of them. They're excellent recommendations. Some of them are beyond us so of course it will be the member states and others who should help in implementing, like the pandemic treaty, I said, the Assess [?] contribution and others.

But what the Secretariat can do we will do. Of course while compiling we have now a very good data bank, pooling all the recommendations. We're also implementing side-by-side. As I said earlier, the Pandemic and Epidemic Intelligence Hub in Berlin will be a game-changer, what we call the collaborative intelligence.

01:09:51

I think it will bring the whole world together and information can be shared through that hub.

We have the biohub. It's a voluntary programme. The biohub is to store pathogens, biological materials and I think so far six countries have already contributed and we expect more countries to give biological materials. This is again going to be a game-changer because this is an area where we had problems. This is also good for emergencies.

Then we have the universal health and emergency periodic review. That will also help. This is similar to the Human Rights Council universal periodic review to assess national capacities, identify gaps - it's peer-review - and then collaborate to address the gaps and national capacity and global capacity can be strengthened.

The Academy will also be a game-changer, the WHO Academy. It can train millions both in person and virtually and it's the capacity that we create which will be very, very important not only for health but other related sectors also can be trained, simulation exercises and so on can be organised through the Academy.

01:11:26

So we have already started implementing but at the same time we have a long list of excellent recommendations that we will list. So the emergency programme will be really significantly different from what it is but the key is the emergency preparedness at the country level so that's where we will invest. Country preparedness is key.

I said it earlier, the muscle memory will help us. I think countries who knew SARS were serious when COVID started and I hope countries will have that muscle memory that will help them to invest more but emergency is about health equity so investment in health will be very, very important.

We want countries to identify health as a fundamental human right and those countries who don't recognise health as a fundamental human right in their constitution to include it in their constitution.

We will push the agenda of health for all, universal health coverage with a strong primary healthcare foundation because that's key for emergency preparedness and response. Of course I can go on and on through other issues but I think since your question was around emergencies, I think we have lots of excellent recommendations that we have already started implementing and will continue to implement and improve our system as soon as possible and make it fit for purpose.

01:13:05

Thank you so much for that question. I think one of our colleagues is complaining from behind so I think it's fine if we can, since this is one after almost two years, let's give the chance until every question is addressed. Tarik.

TJ           Dr Tedros, that will then take some time but as you decide. Katrin.

KA          Thank you so much for that, Dr Tedros. Thank you for understanding that we're here to work and that, as you know, the Geneva press corps has followed the outbreak and then the epidemic from the beginning on and we really appreciate to see you and to be here in person with the experts.

My question is the following. We see regularly that Europe is the epicentre of the infection when it is one of the regions that has the most access to vaccines. We see also that infected people are not only elderly people so I would like to know if you can explain that, your experts and yourself, why the epicentre is always in Europe or in the United States particularly.

01:14:30

Could you please update us about treatments? Because we always talk about vaccines but what about treatments, is there any new information about that? Thank you so much.

TJ           Thank you. Dr Swaminathan maybe would like to speak about treatments. Really if we are going to follow what Dr Tedros suggested in having all questions it will have to be really one short question from everyone. Sorry, Dr Tedros. Soumya.

SS          Yes, thank you, Tarik, and I can be very brief on the treatments. It's really important because we've learned so much about the disease from the beginning and therefore you've seen it from the case fatality rates that were around four, five, 6% or even up to 14% in Italy at the beginning of the pandemic, that these have consistently dropped because of the better management, because of understanding the pathophysiology of the disease and of which drugs work at which stage.

We now understand that early in the disease antivirals can make a difference and so far we did not have any good antivirals. Now we have two oral molecules, pallupirovir and paxlovid. They're both now being reviewed by the guideline development group in WHO for approval and we should have recommendations on their use within the next couple of weeks.

01:16:00

We've also had a series of monoclonal antibodies that are being developed. Of course for omicron there's a bit of a challenge. Many of the monoclonals are not going to work with omicron but soltrovimab, a monoclonal developed by Vir [?] and GSK, that seems to retain activity and we will have recommendations very soon for the use of soltrovimab.

The guideline development group is also looking at a couple of other drugs including fluvoxamine. There've been a couple of trials. It's an anti-depressant, as you know, and it's showed some effect but the trials were not very large and the effect was not huge but the guideline development group is looking at that.

So there's a timeline now over the next couple of weeks to look at each of these drugs and as and when new evidence becomes available from trials on any drugs, any treatments we have a living guideline approach. So the guideline development group updates the systematic reviews and updates the recommendations and so this is a new approach where we are almost in real time updating the guidelines because it's so important to improve treatment and treatment outcomes for patients.

01:17:14

So there will be a few recommendations coming in the next few weeks and of course we hope to see even better treatments coming forward but again the one caveat for oral antiviral treatment that can make a big impact early on is the fact that you need to diagnose the disease within the first three to five days for these drugs to be effective. Thank you, Tarik.

TJ           Thank you, Soumya. Let's then move on. We have four journalists online with their hands up but let's continue here. Gabriela, please.

KA          The first part of my question regarding why Europe is always the epicentre of [inaudible].

TJ           Okay, sorry for that. Dr Ryan, would you like to answer this question on Europe?

MR         I think Dr Abdi is online. Maybe he's in a better position.

TJ           All right. Dr Mahamud, would you like to answer the question on Europe being often cited as the epicentre of the pandemic?

01:18:24

AM         Thanks, I will gratefully and we can share more data later on. As we said earlier on, the biggest risk factor for this has been the age and the population density. Europe and North America have some of the most urbanised areas and so that's a major contribution. If you compare Europe to Africa and to other parts where the population is pretty young the comparison becomes relatively unsuitable.

That's why Europe has the highest death rate, because of the life expectancy and that's why age is a risk factor for this.

The second is, as Dr Tedros said, the long-term investments required for some of the neglected parts of society, long-term care facilities, home-cares and the elderly. As you have seen, a lot of countries, really the most developed countries that have a focus [?], these were neglected, given to social services rather than being seen as a local health investment.

01:19:24

So how we take care of the long-term care facilities. When countries focus on that we have seen a dramatic reduction so daily testing and protection of the elderly.

Third, even before this pandemic Europe had been hit hard with the measles outbreak. The rise of misinformation and mistrust in the government has led to a situation where the vaccine uptake has plateaued.

So now although most of the European countries are going ahead with boosters we have a major chunk of the population that has not accepted. So it's multi-layered and any complex problem like that cannot be saved but I think what we have learned so far is preparedness, preparedness.

Dr Tedros said, when Asia Pacific was hit with SARS they prepared, they prepared their systems in place. Maybe in the next pandemic Europe can learn a lot of lessons and do self-reflection on, one, how do you protect the elderly care, what investment is required and how to bring the population back into the trust and an increase in the vaccine uptake.

01:20:30

But you're absolutely right, there're a lot of lessons and Europe is big [?], as diverse from central Asian countries to West Africa but the western Europe part of the continent.

So in summary it's a multifactorial but if you look into other populations age plays a big part, population density and then the trust in the government and the vaccine acceptance are some of the early factors that come to my mind. But we can give you more detailed analysis later on.

BA          Just to come in briefly on this question as well, Katrin, remember that it's often our perspective as well because the epicentres have been moving continually in this outbreak. You have a huge outbreak in India and surrounding countries.

You had the outbreak in Asia to start and you have the outbreaks in Brazil and yes, Europe has been hit repeatedly but many of these places... And I think there's a danger always, as Abdi relates to, in thinking that this disease is differentially going to affect regions for reasons other than just the demography of it.

We don't have that evidence yet and we've seen so many areas so badly hit and we're always thinking, okay, the place we are today, but we're concerned. Asia could get hit again very, very badly, parts of Latin America could again. It may just simply be a temporal phenomenon that we're looking at.

01:21:59

Because then what people fall into is, oh, we're safe, it's really that part of the world that gets hit. One thing we've seen is big epicentres moving continually with this outbreak. There's a lot of vulnerability, a lot of risk still everywhere in the world.

TJ           Thank you. Bruce, if you can just get your mic a little bit closer to you. That's what Chris is saying. Let's continue here in the room. We have Gabriela, then Jamie and then we will go hopefully online. I still have Christophe, Shoko here. Gabriela. Let's try, if it's possible, to ask questions that have not been asked before.

GA          Okay. Thank you so much. Thank you for having us here. It feels really, really nice to be here so thank you so much. I hope this is not the last - the last one of the year but not for next year.

Dr Tedros, you have mentioned that the omicron variant is spreading in an unprecedented way so I would like to ask a very basic question because I think people are forgetting how this virus spreads.

01:23:10

People forget that COVID-19 is airborne. Could you emphatically say loud and clear that COVID is airborne and what are your recommendations for governments and people considering this characteristic of the virus, especially people who are inside their houses in this harsh winter? Thank you.

TJ           Thank you, Gabriela. On the transmission, I don't know if Mike would like to start. The mode of transmission.

MR         Yes. Since the very beginning of this epidemic and in fact the first guidance that WHO released spoke to the different potential modes of transmission and clearly the role that aerosols could play, particularly in a healthcare environment.

There is no question that this virus can spread by multiple modalities of transmission including both larger and smaller aerosols or large droplets and smaller aerosols. The factors that drive transmission are very much driven by proximity and how close people are together, therefore being exposed to larger doses of the virus regardless of the mode of transmission.

01:24:25

If you're near somebody else you can touch them. If you're near somebody else you can touch a surface they touched. If you're near somebody else you can be exposed to or inhale both large or small droplets or small aerosols.

So in that sense the virus does spread through the air but that risk of being exposed or infected decreases exponentially with distance. However there are circumstances in which that doesn't remain the case, if there's a large group of people in an indoor environment that doesn't have proper ventilation or good ventilation where windows and doors aren't open.

Viruses can certainly build up in those smaller aerosols which are then dispersed by circulating air and there have been circumstances certainly where that has caused events or the spread of disease amongst individuals.

So there are multiple ways in which this virus spreads, all of which occur and all of which can occur in a greater proportion in particular circumstances. That's why we've been saying again and again and again, wearing of masks, physical distance, avoiding crowded indoor spaces in particular, ensuring that there's good ventilation in those indoor spaces.

These are all hugely important issues when it comes to all infectious diseases and particularly with this one. So from WHO's perspective and regarding the advice we have from all our expert groups, WHO's been saying this since the start.

01:25:59

Sometimes this has turned into a political football back and forth around the different modes of transmission. All of these modes of transmission are important, all contribute to the overall transmission story and transmission dynamic of this virus but physical distance from another person and that ability to be exposed to small or large aerosols or touch, or contaminated surfaces all significantly contribute.

What we have been doing is focusing our advice and all of our advice has been focusing on reducing all of those modes of transmission and we have been very consistent in offering that advice for a very, very long time to anyone who will actually listen.

TJ           Thank you. Let's take a few more questions here, then we'll go to the next round from the line. Jamie, then Shoko and then we will go online again. Jamie, please be brief.

01:26:59

JA           Good afternoon, everyone. Thank you again. I'll echo all my colleagues who appreciate the opportunity to get back to headquarters.

I had a very quick follow-up with Dr Pinto Gaspar. Just so that I understand on Sputnik, late January, that's the last of submissions. So that would be the earliest that we would see an approval possibly or in the following weeks? Just a clarification.

Then my other question. I'd like to take a quick step back if I could. There are a number of countries - as Bruce just mentioned that in Asia there could be another spike somewhere down the road - a number of countries have taken an approach of basically trying to lock down and almost wait out the pandemic in the sense that they're putting very strict quarantine measures, making sure...

I'm just wondering, epidemiologically as this pandemic moves to endemicity down the road is it possible to wait out a pandemic like this, are countries actually going to be able to wait this out? I think of China, I think of New Zealand, I think of other countries. Could you just give us a long-term view on it, please? Thank you.

01:28:24

TJ           Thank you, Jamie. Dr Gaspar.

RG         A very quick one on that just to clarify what I said before. The information we have from the applicant is that the final documents will be submitted by the end of January, which means that the evaluation formally starts from there.

I also said before that we will have packages on the quality part of manufacturing. That will be submitted in December and according to that and to the CAPA for previous inspections, the corrective actions and promise actions that are being implemented from now, we are also looking at the preparation for the GMP inspections that according to that deadline, which is a December submission on the quality and manufacturing, could be performed in February, the inspections.

So no date on approval because the approval will depend really on the information, the quality of the information, the qualities and responses and that really will start from the end of January.

TJ           Many thanks. Dr Aylward would like to add something.

01:29:32

BA          Thanks, Jamie, for the question. On whether countries are trying to wait it out and whether they will be successful in that regard, no country is really trying to wait out the epidemic or the pandemic. As Mike said, this is a virus now which has demonstrated it's going to be around for a long time. We need to learn how to live with it.

What most countries that have maintained very strict travel restrictions or other measures in that regard have been trying to do is get their vaccination rates up and optimised on the one hand.

The second thing they're trying to do is understand the evolution of this virus and how to stay ahead of it, a little bit to some of the questions asked earlier. How effective are the current vaccines going to be against it?

The third thing that people are looking at is the advent of new tools and Dr Swaminathan talked about this earlier but at the beginning of this pandemic... I remember when the Director-General asked me to be involved with helping to co-ordinate the ACT Accelerator.

Phase one was really the scale-up of the new diagnostics because the rapid diagnostics had just come on. The next phase became the era of vaccines and now we're in a very exciting period when there are more and more therapeutics that look as if they could play a role. We've heard about a number of those in recent weeks.

01:30:52

So I think what most countries are trying to do is optimise their vaccination coverage. They're also trying to optimise their public health systems. I remember when I led the mission into China last year, one of the big things that they were looking at was the level of preparedness before they lift measures. How much testing could they do, how many people would they be able to isolate if needed, how many people could they take care of?

So they realised that they had basic issues around capacity that needed to be in place so that if they were to try and open up again going forward they wouldn't get overwhelmed. So most countries are looking at it in that context. I don't think anyone now is thinking, we'll wait this out until this goes away, because clearly we need to be more proactive in our management and thinking about it.

01:31:41

Coming back to one of the earlier comments we made about distribution of production capacity, we come back to this again and again. We've got to make sure all of these tools can be made in as many places as possible to optimise access and we aren't there yet.

TJ           Thank you. Dr Ryan would like to add something.

MR         Just following up on what Bruce said and I think, Jamie, you referred to Asian countries. There's a hugely diverse experience in Asia. In fact the vast majority of countries in the Western Pacific and Asia did not do full lock-downs, they did not close their borders, they did not isolate themselves from the world.

One or two did, particularly those who could maintain sea borders and air borders and that didn't have land borders with other countries. I certainly, speaking from a European perspective, would love to have the numbers that many countries in Asia have, particularly the numbers of hospitalisations and deaths and while all deaths are tragic the scale of death, the scale of hospitalisation in many Asian countries has been quantums lower than Europe and the Americas.

That has come from the implementation of a layered strategy with a focus on testing and contact tracing within a community that was willing to engage with and comply with government advice and that took hat on board and that was able to sustain that over a long period of time.

01:33:17

Yes, as Bruce said, we always knew at the beginning it would take three to nine months to develop vaccines and potentially antivirals and other things so it's not about waiting something out. It's about holding a disaster at bay until you have better means of response and you use what you have.

What the world didn't do was use what it had. It looked for tools down the line. Some countries didn't. They actually took on board what they needed to do to suppress infection, to protect their populations, to do testing, to do contact tracing, to shore up their hospital system, to move healthcare workers around, to engage with and educate communities and get trust and compliance from their communities for a prolonged period of time, and then be able to bring your population up to higher levels of vaccination.

01:34:10

It doesn't mean that these countries won't have cases going forward. Of course they will and it doesn't mean that some of them won't have difficulties or challenges. Of course they will but what they did do was use the tools that they had to their best advantage and, as Dr Tedros said earlier - and I think this is absolutely crucial - they had the experience of SARS in 2003, of MERS in the likes of Korea.

There was a high level of awareness and a high level of pressure from communities to governments to make sure they did things. Communities expected coherent action from government, they expected testing, they expected contact tracing, they expected they would be protected to the best capacity of any given government.

But the strategies if you go from Thailand to Korea to Vietnam to Australia and New Zealand, they're all nuanced and they were quite different in their approaches. But to me when we look at the actual case numbers, when we look at the actual deaths overall Asia has done a remarkable job in being able to contain and suppress this virus in reality.

That does not mean that they don't face the same difficult way ahead that we all do in the coming months.

01:35:28

TJ           Thank you. Can we go really, really fast for one of the questions that we have in the room? Shoko. Christophe, very briefly. Shoko.

SH          Thank you, Tarik, for taking my question. Dr Tedros, you mentioned in September that high-income countries had promised to donate more than one billion doses but less than 15% of those doses have materialised. May I have an update on this and what commitment by high-income countries is necessary to end this pandemic next year? Thank you.

TAG        I think we're better off in terms of donations we're getting, it's getting better and better but I would like to give the floor to my friend, Bruce, for the figures. But there is improvement from then and there's better flow now and even through COVAX, in the past few weeks we have distributed more than in the past nine months.

So it's improving, it's getting better but still not enough. Bruce.

01:36:47

TJ           I think Bruce is looking for figures.

BA          Yes, Bruce is frantically trying to pull up the numbers to make sure, Shoko, I give you the most recent ones. I haven't quite got there yet but I'll pull them up and maybe we'll come back to this to update you.

But indeed we have confirmation now of planned donations of over a billion doses. Of that though only a fraction still have been delivered. We're actually just over 15% of the total. Part of the challenge there, Shoko, is what we're still getting is they're making new pledges so the pledge number is going up and they're going up proportionally, the number actually shifts.

I'll pull up the numbers for you in a moment but in terms of what governments could do, the other important thing to remember, folks, is as long as we're donating doses the control for the supply rests with the donating countries.

COVAX right now is funded, it's been very generously funded and has a lot of contracts with a lot of manufacturers and what we need is that the COVAX contracts are prioritised. So when you say, what can high-income countries do, allow the COVAX contracts to be prioritised because the manufacturers will say, oh, it's not us, it's the high-income countries who've got contracts.

01:38:03

Then they will say, no, it's not us, it's the manufacturers who make the decision who gets the doses next. What we need is transparency. In one word, we need transparency. We need manufacturers to answer your questions, to say, how many doses are you shipping, which month, to COVAX, to the others, so that we can then prioritise those. That is the single most important thing.

There's a danger that we create a perverse incentive if we keep pushing donations. We meant for that to be a stopgap measure when we didn't have doses but if it becomes our main way of supplying countries we still don't get to what would be the optimal situation where countries control the vaccines they're getting.

Because remember, with donations, folks, you don't get a choice about the expiry time frame so we're getting short expiry dates, which makes it very hard to use them. You don't get to choose the product, you're donated a specific product so some countries have got multiple products in their system, which are very complex to manage, instead of one or two key products.

01:39:07

So all of these things are complicating the situation. Very grateful for donations, great, make sure you send the donations that you've pledged. But at the same time please prioritise the COVAX contracts. Sorry, I think you can tell how little sleep we're getting these days. I'll pull up the numbers and come back to those.

TJ           Thanks. Yes, please.

CR          Christophe Vogt, Agence France Press. My question was about disinformation and...

TJ           Christophe, if I understand well, it's about convincing people to get vaccinated.

CR          It's about disinformation, how you fight disinformation to get people to do the right thing.

TJ           Yes. Who would like to speak about misinformation? Dr Ryan, would you like to try?

MR         I can begin. Soumya and others and Bruce can speak to the issue of vaccine hesitancy but certainly there's been lots of disinformation in this pandemic, not least to do with vaccines. I think that's part of the problem in epidemic response. It takes six months to develop a vaccine.

01:40:24

In the first six months of this pandemic there was so much misinformation and so much toxicity that it was very, very difficult to be able to bring a vaccine in and have full acceptance for any product in the toxic environment in which these interventions have to be done.

Bruce, myself and others have spent the best part of 30 years responding to epidemics on the front line. Vaccine hesitancy or hesitancy or distrust of external interventions or what is perceived as external is very, very common. It's more common than it's not.

People have justified questions about any product or any intervention that they see or that they perceive as being imposed on them and they need to have those questions answered.

In many, many communities around the world people who are living on the edge of society - irregular migrants, people who are living in slums, people who are poor, people who feel oppressed.

01:41:29

You come along with an intervention like contact tracing or you come along with vaccines or you come along and say to people, you must do this and you must do that, if those people haven't seen you for years, you've never been there to support that community, if those people live in poverty, if they live excluded from all the things that others have then it's very, very difficult to come along at the very end and say, you must take this vaccine.

So I think we've been dealing with a trust deficit between governments and populations for many, many years. We've been dealing with social inequity and social injustice that has generated a lot of distrust.

We are dealing with misinformation, yes, and there is wilful misinformation and, yes, that can occur and people blame young people or the social media. That's not the most poisonous misinformation. That happens and we need to get better at getting good information to people, we absolutely do need to get better at doing that.

The infodemic that people have had to suffer has been greatly stressful on them but we can deal with that. But the most poisonous part of all of this has been the political process, the misinformation, the populism and the manipulation of communities and societies for what are very venal ends.

01:42:45

So we have to separate in this what is genuine hesitancy and questions that we need to get better at answering, the infodemic that spreads on social media where we have to be very careful to get good information to people and then the wilful use of misinformation by extremist groups or within politics which has led to the poisoning of trust between communities and between communities and governments.

TJ           Thank you, Dr Ryan. I don't see any more hands... Dr Tedros, yes.

TAG        Maybe to add to that, Tarik, on the misinformation and disinformation I just would like to add to what Mike had said, as Mike said, there is a serious trust deficit and that has to be addressed.

From our side, we believe that it should be done both at country level and global level. For instance, if I take the global level we're partnering now with tech industries. Most of the misinformation and disinformation is coming in the social media so lots of people are influenced by that and we get a lot of material actually from the social media.

01:44:15

They send it to us saying, is this true, is this true? Which is completely fabricated actually and it affects many, many people. So working with the tech industry, we've found, is important because it directs people to the WHO website and also to other trusted websites in countries.

But it's a very difficult task, it hasn't started now. It was there, especially with vaccine hesitancy or anti-vaxers so we need to sustain our response.

Maybe the other part with misinformation which I would like to add is we do campaigns to vaccinate and a good number accept being vaccinated, maybe 60% or 70%. But we have to combine it with targeted campaigns or targeted engagements.

People who have not been vaccinated - I said it earlier - are now 80% of deaths even in high-income countries. So we need to engage those who are not being vaccinated one by one and see what the reason is - they may have a genuine reason - and try to address that.

01:45:55

Using other health workers, I think, talking to each other in the privacy of their home will be very, very important to understand why and really target those individuals to make them get vaccinated.

There're some countries who have already prepared a map of their villages for instance and who is vaccinated where, especially the older age groups and head-hunting to vaccinate those who have not been vaccinated.

So that could also help in addressing the vaccine hesitancy or the resistance because people could understand more when they get more information in private because they can have a chance to ask questions.

So the vaccination campaign can take us some distance but the remainder should be filled through a very private individual-based micro-plan that can address the problems faced by the individual or that the individual is raising.

01:47:14

Not only during COVID, by the way. With Ebola we had a serious distance in eastern DRC, in Beni, Butembo, Katwa and we were stuck for some time because there was a lot of resistance. Then the involvement, the engagement of the community through its leaders - religious leaders, business leaders, traditional leaders, political leaders - helped and even for this in countries who have problems I think if the leaders could speak the same language it could help.

When I say leaders, there could be differences even between the leaders but at least the same message should be sent to their followers from, whether it's religious, traditional leaders or political leaders or other leaders. Thank you, Tarik.

TJ           Thank you. Have we finished with the room here? I think so. Let's see. Who do we have still online with hands up? I've got a message from Moussa that he's online. Let's start with Moussa. Moussa.

MO         [French language].

TJ           Moussa, we don't have a translation here today.

MO         It's okay, no problem. Shukran, Tarik. My question is about Dr Swaminathan. As she said, we don't know if the vaccines will switch to doses every six months or annually like influenza vaccines.

01:49:10

As you know, Dr Tedros, some poor countries have not yet received their first dose. When can these countries get a third or perhaps fourth or fifth dose, what about the future of these countries if the policy of inequitable distribution of these vaccines continues? Shukran.

TJ           Thank you. Dr Aylward is also ready. Dr Swaminathan, Dr Aylward.

SS          I could start very briefly. Just to say that this is exactly why the Director-General appealed to all countries and he's been appealing since the beginning, ever since we had vaccines at the beginning of the year, for equitable distribution.

The goal was, let's cover the vulnerable groups in all countries first, that will bring down deaths, that'll bring down mortality, we can end the acute phase of the pandemic and then go on to vaccinating the others progressively, younger people, adults and so on.

01:50:16

But that did not happen and as you mentioned, we today are in a position of these very stark inequities in access to vaccines and so then the Director-General announced a moratorium on boosters until the end of 2021 with a goal to covering 40% of every country's population.

We have enough vaccines being produced now, by the way, one-and-a-half billion doses or so every month. It's just that they're not getting to all the places they need to be and so there are two tracks here.

There's the science behind the vaccines. How long does immunity last, how well does it cover the different variants, what happens to people of different age groups? This is going to evolve. As Dr Ryan was saying earlier, we will move ultimately to a situation where this infection becomes endemic, doesn't cause as many deaths but it still causes infections, it still makes people sick.

Some people may still need vaccines, maybe everybody's not going to need vaccines every year, we don't know. These are the questions that data and science will answer as we progress.

01:51:27

But for the time being I think what is really key is that we get vaccines to cover the vulnerable people and I think Dr Tedros has mentioned several times today that the people in the hospital today, even in the high-income countries, are largely the unvaccinated.

So even though there's enough supply of vaccines in those countries there are still a lot of people who have not received either their first or second doses so there's a lot of work to be done in high-income countries accessing those populations for a number of different reasons.

Some of it is misinformation, as Dr Ryan and Dr Tedros just spoke about. Some of it is just lack of access, old people, disabled people, people who have questions, who have doubts, who can't get to the vaccination centres.

01:52:18

So countries need to go down, very granular, to the local level and have interventions so that every individual has an equal opportunity to have the vaccines as conveniently as possible.

Then of course there's the group that's resisting vaccine and we have to keep trying to convince them but this is in countries where there're adequate supplies. In countries without supplies, as Dr Aylward said, we have to do everything possible through COVAX and through AVAT to get those supplies into the arms of people in those countries and it's going to mean vaccines flowing into those countries.

It's also going to mean that they need some financial support, they need technical support, they need logistic support. It's not an easy task getting millions of adults vaccinated. No country has done this kind of vaccination campaign at this scale before and while a lot of countries have done a tremendously good job there are many countries struggling and we need to help them and this is where, I think, we're trying to come together.

We're trying to bring donor countries together, we're trying to bring manufacturers and everyone to work together to achieve that goal because if we have to see the pandemic end then we have to work together to achieve that. Thanks. I'll stop there.

01:53:38

TJ           Thank you. Dr Aylward.

BA          Thanks, Tarik. To Moussa's specific question of when there will be enough vaccine, in the first quarter of next year there's enough vaccine to vaccinate 40% of the population of every country in the world, plus give a third dose to everybody over 50 years of age.

There was a question earlier from Christiane about the ability to give those so we are very quickly getting into a situation where the production capacity is sufficient. The challenge now becomes the supply side, making sure it gets to the right places, the right products and then making sure that these countries that have been starved of vaccine so long, where they've not gotten vaccines, they've gotten all the problems from the high-income countries in terms of rumours about vaccines, product preferences, etc, and now they've got to try and reverse all of that.

So our big pivot for the beginning of next year will be optimising the allocation to make sure it goes where it's needed and then make sure the places it's going have got all the support that they need to be able to put those doses to that use.

01:54:45

If I might just come back to Shoko's earlier question, sorry, Shoko, I try to give you this data in real time and every now and again one of the data sets crashes and I couldn't get it for you but now I have.

We've had pledges of about 1.5 billion doses of donations to COVAX or through the COVAX mechanism. Of those we've been able to allocate 500 million doses so that's over one-third of those doses, which is really important. That means the countries have actually signed over to COVAX and to the COVAX facility those doses, not just a verbal pledge.

Of those doses 312 million - the exact number - have actually been shipped into countries so we're up at about 20% of them actually having been shipped. That's good because as the donation pledges are building up we're actually starting to catch up with the numbers that are actually being shipped as well.

01:55:38

Then, as you've probably seen on our sites, COVAX has now shipped nearly 800 million doses. It should hit 800 million by the end of this week and of those over 300 million of them will have been donations.

So it's been very, very important, we're very, very grateful for those, keep the donations coming but with longer lead times on them, more transparency on the products and at the same time please don't disadvantage the contracts that COVAX has because that's when we really have control of the supply and we can do our best to try and address inequity.

TJ           Thank you, Dr Aylward, thank you, Dr Swaminathan. Dr Ryan and Dr Mahamud have to leave so let's hope we will be able to answer the remaining questions with the panellists that we still have. Let me call on Xin Ji from China Radio International to ask the question. I understand the question is about different variants. Xin.

XI           Yes, can you hear me?

TJ           Go ahead.

01:56:48

XI           Thank you. Thank you for this opportunity. With the high number of both delta and omicron cases currently circulating in the world we can imagine a more likely scenario that someone could be infected by both delta and omicron.

Recently Moderna's Chief Medical Officer, Paul Burton, said it was certainly possible omicron and delta could team up and create a more dangerous strain. I want to ask, what's the opinion of WHO, can delta and omicron combine to make a super-strain?

TJ           Thank you. It's a pity that we don't have Dr Mahamud with us. Maybe Dr Swaminathan can try.

SS          Yes, I can certainly try. It's still a question about how these variants are arising and omicron in particular, the scientists who study these things, the evolutionary pattern have found it extremely surprising that the omicron seems to have emerged not from delta but from a lineage which is quite distinct from delta.

So it's very hard to predict what the next variant is going to be. In fact many scientists have said it will be difficult for the virus to have another variant which is even more transmissible than delta because delta was considered so efficient in transmitting and yet we have omicron, which has a very high growth rate, it's very transmissible and it is able to evade our immune responses.

01:58:43

So it is hard to predict and I think it is unpredictable. The virus has done things to surprise us all the time. One thing we can be sure of is that it will keep on evolving, that's for sure and so what we need to do is to stop transmission because the only way to reduce the chances of new variants coming is to try to control transmission as much as possible, don't give the virus opportunities to multiply at the kind of pace at which it's doing around the world now.

As for the specific hypothesis that delta and omicron might recombine in some way and create a new variant, I don't have a specific answer to that. Perhaps it's a hypothesis that's been proposed but what we do know is that the virus will continue to evolve and mutate and we have to keep tracking it.

That's one of the reasons why we are also helping countries and telling countries to strengthen their genomic surveillance. We still have a large number of countries that don't have the capacity and that means that we really cannot discover what is happening in those places.

01:59:57

It was because of South Africa's absolutely tremendous scientific leadership in this area that so quickly after a new variant emerged and new clusters started coming up they were able to actually sequence and tell us that there was something new going on.

So again this is something that's evolving and we're going to learn more and more about this virus. I'll stop there, Tarik.

TJ           Dr Aylward.

BA          Yes, thanks, Xin, for the question. I actually hadn't heard that but there've been other conversations about possible recombinations of these viruses but remember, folks, that most of the variants that we've been seeing have been evolutions of one virus. They aren't recombinations of viruses, on the one hand.

The other thing is, it's not as simple as a virus simply recombines and takes the worst of both and becomes an even worse virus because viruses, of course, as they accumulate mutations sometimes they become less fit.

02:00:58

It's a very small proportion of these viruses that take off. Everyone's an expert now. You know how plastic this virus is and how regularly it mutates so it would not at all be a foregone conclusion and I think with so many things to be concerned about about how people are responding, how they're getting vaccinated, etc, introducing new speculation into this is not particularly helpful right now.

TJ           Thank you. I understand we have two more questions and if it would be possible, Chris, let's call on our friend John Zaracostas.

JO          Yes, good evening.

TJ           Good evening.

JO          Can you hear me, Tarik?

TJ           We can hear you, John.

JO          Great. My question is if you could bring us up to speed on the ratio in emergency and intensive care units of nurses and other support staff to doctors and the mortality ratio, and secondly if Dr Tedros can bring us up to speed, if there will also be more transparency and openness to events that WHO holds on pharmaceutical pricing at [?] WHO in the future. The press are consistently kept out of these.

02:02:22

TJ           Thank you, John. Unfortunately Dr Ryan is not there, who could speak more about the situation in hospitals and... But maybe on the second point, we can speak about the manufacturers and transparency of prices.

TAG        The second one. Do you want to start, Gaspar? Anyway, I would like to respond to this. We believe in transparency so if there are some specific instances where you were not able to attend it would help if you'd please let us know but I will also talk to my colleagues so that you can have access to information, including pricing. Okay, that's John's question.

The second one is in general about health professionals. Our concern now is many are leaving the system and many countries including high-income countries are losing their health professionals and this is because of COVID. They have been working day and night for more than two years now and many of them are burned-out without even appreciation of what they're doing.

02:03:54

They even face lots of challenges including violence, by the way. During the first instance of the pandemic there was a lot of support, you remember, but that has to be translated into action and countries, governments should help in making sure that their work environment is better and they should really do better in terms of pay, in terms of training and other support that they can give to the health professionals.

So COVID is actually challenging the whole health system because when we need more workforce, be it nurses or physicians, we're actually losing and there was a serious gap, eight million even before COVID to achieve SDGs.

Now it's even getting more and you can understand, I think, the frustration and all the problems they're facing and I hope you can help us in reminding countries to really invest in the health systems, especially in the workforce.

So thank you so much. I think that's the last question. Or do you have one more?

TJ           We have one more but I think Dr Aylward would just like to add something first, if I'm not wrong.

02:05:26

BA          I don't want to speak after the boss but just to remind colleagues that one of our partners in COVAX, UNICEF, does maintain the vaccine market dashboard which does provide price breakdowns on all the available data, on the prices that different countries [sic], different products are being sold for in different income markets as well so it is an important source of data.

WHO also participates with UNICEF in the collection of the data behind that so we do try as best we can to promote the transparency, to the Director-General's point so that site is available, John.

TJ           Thanks. John, if we didn't answer the question entirely please send us an email and we will help. Now we go to our last question, to our friend, Nick Cumming-Bruce from the New York Times. Nick, the floor is yours.

NI           Thank you very much and thank you for extending this press conference to take all the questions. It's a quick question. About a week or so ago you were cautioning us against considering that the omicron variant was causing mild infection but we don't seem to have seen a very significant level of severe infection or death linked to omicron and specifically not among people who are not suffering from comorbidities.

02:06:58

So I wonder if you could comment on whether that impression is correct and if that is the case is the main threat from omicron simply the transmissibility and the scale of infection that's resulting from it? Thank you.

TJ           Thank you. The line wasn't the best but I think the question was about transmissibility and possible severity of omicron and what we are getting as a result. Dr Swaminathan, would you like to try?

SS          I can start. Yes, I think it's early days to conclude that this is a milder variant. There are a couple of lines of evidence. The first of course is the data from South Africa that showed that the hospitalisations during these weeks of the omicron surge have been less than the hospitalisations they had during previous waves with the delta and other variants.

They also found that even for people in hospital there were fewer people who needed oxygen, fewer people who needed the ICU. But on the other hand South Africa has had huge surges in the past and the seroprevalence so some immunity due to previous natural infection and due to some vaccination is quite high in Gauteng [?] province and that could account for the milder nature of this because this is a second infection or a third infection.

02:08:28

It's a reinfection so there's already some pre-existing immunity and this is true for many countries now where a good proportion of the population has some immunity again either due to natural infection or vaccination or both and therefore this variant may be behaving differently in people with prior immunity, populations with some pre-existing immunity.

That's what we hope will happen in the future, that variants will not cause severe disease and death but there are caveats here. The first is that it's early days and as omicron takes hold - and the way it's spreading, it is going to spread around the world - unvaccinated people will get infected, elderly people will get infected. We'll have to see whether this continues to be mild in them.

The other thing is that if you have a huge number of infections and even a very small proportion of them are going to be sick you'll still have enough sick people to fill up hospitals and to overburden the healthcare system.

02:09:34

So for this reason it is probably unwise to sit back and think, this is a mild variant, it's not going to cause severe disease because I think with the numbers going up all health systems are going to be under strain and they already are in many countries, including in Europe.

Then of course finally every case in the world is not being sequenced and so information that we get from GISAID is on a subset of samples, positive patients who are then sequenced and this varies from country to country.

Some countries do 20, 30% of the cases, they sequence. Other countries are doing less than 0.5% so right now delta is still predominant but omicron seems to be gradually creeping up in many countries that are looking for it and sequencing so I think it's still early days.

02:10:28

There was a recent report from Hong Kong that showed that omicron seems to multiply better in the upper respiratory cells from the nose rather than in cells from the lung, indicating that maybe it's going to be more of an upper respiratory infection than causing pneumonia.

If it is true it will be very good news but I think we have to wait and watch. The WHO has a clinical data platform. We're requesting people from around the world who are seeing patients to submit their data onto that clinical data platform because that's the way in which we'll be able to analyse, aggregate data from around the world and come to some conclusions about clinical features and severity and see if there are differences from previous variants. Thank you.

TJ           Dr Aylward.

BA          Nick, thanks for the question. I want to just tell an anecdote from last week on this issue of omicron as a mild disease. We were talking on, I think, Thursday of last week with the leadership's office in one of the countries that were experienced in the disease [?].

We called them and they said, it's looking a little bit mild, we don't see as much hospitalisation, we don't see this, we don't see that. We said, okay, we'll stay in touch, check back later. Then I got a call from the head of state's office that afternoon saying, hang on a minute, hang on a minute, we've had a surge of deaths and a surge in hospitalisations, they all came through today and we definitely are not considering this a mild disease.

02:12:04

I just want to say that not because it says it's a severe disease or a mild disease but just how much the information is vacillating right now and part of this is because a lot of the data are coming from very specific situations where it's either a younger population, a highly exposed population, a highly vaccinated population.

So it's still very difficult and in the face of uncertainty the natural desire at this point in the pandemic is assume the best when the right way to tackle a disease like this, we should have learned by now, is respect this virus, we don't understand it yet.

The other thing is just remember the consequences. If all of a sudden everyone thinks, this is a mild disease, okay, we take off the masks, we stop our social distancing, we have... The delta virus is lurking everywhere and just surges in that environment as well. We're not dealing with a single virus, just the omicron so that can't be what drives the global response.

02:13:01

So again, sorry to harp on on this issue but we're in a period now with escalating disease in many parts of the world and people looking to find solace in the idea that it might be mild. It may be mild for some people who've been exposed but there are highly vulnerable people who are going to have severe disease and some of them are going to die who don't need to if we do the basics like Mike just keeps hammering, and you, the Director-General.

Masks, distancing, play it safe, get vaccinated.

TJ           Thank you, Dr Aylward I think there are no more questions so we will conclude here. Just for your information, we will be sending out a recording to the global media list. We will give you some time, an hour or two as this was exclusive to you but there is lots of interest and there was so much being said and thanks to the generosity of Dr Tedros we went on for the longest briefing in the last two years that was organised by WHO.

Before I give the floor to Dr Tedros and maybe Dr Jakab as well, maybe just to remind you, let's let our speakers go out and then we will orderly leave the room ourselves together with you. Dr Tedros.

02:14:26

TAG        Thank you. We had hoped that we would get questions for the other programmes too, not only COVID. That's why Dr Zsuzsanna Jakab, our Deputy Director-General, is here and also Dr Samira Asma but I don't think you had any questions so I would like to give you the floor first and then I will close. Any closing statement that you have.

ZJ           Thank you very much, DG and dear colleagues. Of course I would never speak after the DG. We were hoping to get additional questions on the other programmatic areas because during this year we have been working very hard to implement also the work in the other areas.

We are very proud to say that we reached about 95% of implementation rate, which is very good and we are planning now for the next biannual and the next biannual will be about building back and building forward and hopefully strengthen our efforts to reach the triple billion target and the ESG target.

02:15:39

So next time around when we have the briefing I hope that we can focus also on those areas of work. This time it was more about COVID and the response to COVID but next time it would be good also to discuss what we can do, what we can do together on the other programmatic areas where there are huge needs and huge challenges as well.

If you followed the discussion during Universal Health Coverage Day, you have seen the global monitoring report on UHC and particularly the drawback that we have on the financial protection and we said that on the financial protection and also on the UHC billion and it is really critical that we speed up our work in this area and particularly invest into financial protection and into the resilient health systems based on primary healthcare and integrated with essential public health function.

The other very important area would be the well-being strategy, which is an outcome of the Global Conference on Health Promotion last week, which is crucially moving forward and there we really need a paradigm shift towards prevention and health promotion, which can bring a gain and reduction in global mortality rate by 50% if we really invest into that area of work.

The well-being strategy and the health promotion conference very clearly indicated that well-being equity and the SDG targets, the triple billion targets are very closely interlinked.

02:17:27

So I would say that these two areas of work are very important for next year, [unclear] and building forward and, as we will suggest to the executive board and the World Health Assembly, to extend the GPW by three years and hopefully they will accept it by 2025. There will be three years ahead of us when we can start building back.

These are two areas of work that we think are really critical for the world, for the member states and we need a country-based approach here. Thank you very much. Thank you, DG.

TAG        Okay. Thank you. Maybe in closing I would just like to say a few words about the last part, the omicron. It was part of my statement, I think, last week and as the colleague from the media asked, it's not about the mildness or severity. Even the rate of infection, the transmissibility is enough because of the sheer number of cases that many overwhelm the health system and as a result because of lack of management people could die.

02:18:56

So it's very serious and we're really, really worried. It can double in 1.5 to three days and that's really fast but apart from that, as Bruce said, of course so far evidence shows that it's mild but if this is among vaccinated or among people who had infection already or other reasons or less vulnerable people the data may not be really representative.

So we have to wait and get more information, collect more information before we understand the real behaviour of this virus. We have been surprised many times so we should not be surprised any more. We have to take this seriously and collect as much information as possible to understand, while doing all we can because we have the tools, we have the vaccines and the rest, the masks, the distance so we should use the tools we have.

Then the last part is something omicron could use as a vehicle, which we're really worried about. During this festive season many people get together and there are even many countries' national events that draw a big population.

I think countries should really be very careful to limit that. They have to limit those crowds or crowding because that will be a perfect platform for omicron to spread.

02:20:50

So during this festive season and other cultural, national events governments should take the utmost care and make sure that this thing could be probably postponed for some other time. It's better. I said it in my speech today. Better postpone or delete the events than delete or have people killed.

So we can postpone the events, meaning we can save lives. With that, Merry Christmas and Happy New Year and look forward to continuing our strong partnership next year. As I said in my opening statement, thank you so much for your co-operation and thank you, by the way, our colleague from Anadolu, Tashakur [?]. He was here for another event when a minister visited and he asked me then to organise this.

I said, okay. We have of course this moment although we are disappointed that we cannot invite you for some reception but we said, we need to cancel that to stay safe. I hope you will understand and we will do the reception next year when things are better so still count on me. Maybe another excuse to meet again next year, early, not at the end of the year but as early as things get better.

Thank you so much again.

02:22:49