Monkeypox, COVID-19 & Other Global Health Issues Virtual Press conference transcript - 27 July 2022

Overview

TJ           Hello to everyone from Geneva, headquarters of the World Health Organization. My name is Tarik and I welcome you to the regular WHO press briefing on COVID-19, monkeypox and other global health issues. Today, with us, we have a number of guests here in the room and WHO officials online.

00:01:30

I will start by presenting our speakers in the room. We have Dr Tedros, WHO Director-General, Dr Mike Ryan, who is Executive Director of WHO Health Emergencies Programme, Dr Soumya Swaminathan, our Chief Scientist. Dr Maria Van Kerkhove is a Technical Lead for COVID-19. Dr Rosamund Lewis is a Technical Lead for monkeypox. Dr Rogério Gaspar is Director for Regulation and Prequalification. We also have Mr Tim Nguyen, who is Head of Unit for High Impact Events.

We also have a number of WHO officials online and I will introduce them after the opening remarks. Just to remind you one more time that we have simultaneous interpretation in six UN languages, as well as Hindi and Portuguese. Journalists who are online, please click the icon Raise Hand to be put in the queue for asking questions when we come to that. With this, I give the floor to Dr Tedros for his opening remarks. Dr Tedros.

TAG        Thank you. Thank you, Tarik. Good morning, good afternoon, and good evening. As you know, on Saturday I declared a public health emergency of international concern over the global monkeypox outbreak. More than 18,000 cases of monkeypox have now been reported to WHO from 78 countries, with more than 70% of cases reported from the European region, and 25% from the region of the Americas.

So far, five deaths have been reported and about 10% of cases are admitted to hospital to manage the pain caused by the disease. This is an outbreak that can be stopped if countries, communities and individuals inform themselves, take the risks seriously, and take the steps needed to stop transmission and protect vulnerable groups.

00:03:51

The best way to do that is to reduce the risk of exposure. That means making safe choices for yourself and others. For men who have sex with men this includes, for the moment, reducing your number of sexual partners, reconsidering sex with new partners, and exchanging contact details with any new partners to enable follow-up, if needed. The focus for all countries must be engaging and empowering communities of men who have sex with men to reduce the risk of infection and onward transmission, to provide care for those infected, and to safeguard human rights and dignity.

Stigma and discrimination can be as dangerous as any virus, and can fuel the outbreak. As we have seen with COVID-19, misinformation and disinformation can spread rapidly online, so we call on social media platforms, tech companies and news organisations to work with us to prevent and counter harmful information.

Although 98% of cases so far are among men who have sex with men, anyone exposed can get monkeypox, which is why WHO recommends that countries take action to reduce the risk of transmission to other vulnerable groups, including children, pregnant women and those who are immunosuppressed. In addition to transmission through sexual contact, monkeypox can be spread in households through close contact between people, such as hugging and kissing, and on contaminated towels or bedding.

00:05:51

WHO recommends targeted vaccination for those exposed to someone with monkeypox and for those at high risk of exposure, including health workers, some laboratory workers, and those with multiple sexual partners. At this time, we do not recommend mass vaccination against monkeypox.

One smallpox vaccine, called MVA-BN, has been approved in Canada, the European Union and the US for use against monkeypox. Two other vaccines, LC16 and ACAM2000, are also being considered for use against monkeypox. However, we still lack data on the effectiveness of vaccines for monkeypox or how many doses might be needed. That’s why we urge all countries that are using vaccines to collect and share critical data on their effectiveness.

WHO is developing a research framework that countries can use to generate the data we need to better understand how effective these vaccines are in preventing both infection and disease, and how to use them most effectively. It’s important to emphasise that vaccination will not give instant protection against infection or disease and can take several weeks. That means those vaccinated should continue to take measures to protect themselves by avoiding close contact, including sex, with others who have or are at risk of having monkeypox.

There are also challenges with the availability of vaccines. There are about 16 million doses of MVA-BN globally. Most are in bulk form, meaning they will take several months to fill and finish into vials that are ready to use. Several countries with monkeypox cases have secured supplies of the MVA-BN vaccine and WHO is in contact with other countries to understand their supply needs.

00:08:26

WHO urges countries with smallpox vaccines to share them with countries that don’t. We must ensure equitable access to vaccines for all individuals and communities affected by monkeypox in all countries, in all regions. While vaccines will be an important tool, surveillance, diagnosis and risk reduction remain central to preventing transmission and stopping this outbreak.

Meanwhile, although the COVID-19 pandemic is far from over, we are now in a very different situation to where we were a year ago and we have learned a number of important lessons. One of the most important is that the most effective way to save lives, protect health systems and reopen societies and economies is to vaccinate the right groups first.

Even in some countries that have reached 70% vaccination coverage, if significant numbers of health workers, older people and other at-risk groups remain unvaccinated, deaths will continue, health systems will remain under pressure and the global recovery will be at risk. This is not theoretical, this is real.

COVID-19 deaths have been increasing for the last five weeks and several countries are reporting increasing trends in hospitalisations following waves of transmission driven by Omicron subvariants. Last week, WHO launched an update to the Global COVID-19 Vaccination Strategy, emphasising the need to vaccinate the most at-risk groups, including 100% of health and care workers, 100% of older people and 100% of those at highest risk.

00:10:33

We continue to urge all countries to strive for the target of 70% vaccination coverage with a focus on targeted vaccination strategies that prioritise the most vulnerable, which is the most effective way to save lives. While vaccines have saved countless lives, they have not substantially reduced transmission. So, it’s vital for governments and the private sector to continue collaborating and investing in the development of new vaccines that prevent both infection and disease.

We also need vaccines that can be delivered more easily, such as through nasal sprays or drops. Crucially, it’s essential as new vaccines and other COVID-19 tools are developed, they are available equitably to all countries. In addition to vaccination, WHO urges all countries to assess and strengthen their readiness and response plans for future waves of transmission, including surveillance, testing, strong clinical management and a well-equipped health workforce. Tarik, back to you.

TJ           Thank you, Dr Tedros. Before we go and start with questions, let me just introduce WHO officials who are online and who may also answer some of the questions. We have Dr Socé Fall, who is Assistant Director-General for Emergencies Response. Dr Kate O'Brien is the Director for Immunisation, Vaccines and Biologicals. We also have Dr Ana Maria Restrepo, who is a Lead on Research and Development Blueprint.

00:12:31

With us is also Mr Andy Seale, who is Adviser to the Director of the WHO Department for Global HIV, Hepatitis and Sexually Transmitted Infections Programme. We may have some others, as well, who may join at some point. With this, let’s start with the first question and that will be Shoko Koyama, from NHK. Shoko, please unmute yourself and go ahead.

SK          Hello, Tarik. Thank you for taking my question. On Saturday, the WHO issued a set of temporary recommendations in relation to the outbreak of monkeypox but these recommendations are issued for state parties and I couldn’t quite get the recommendations for the general public. Could you elaborate the measures that the general public can take against infection? Thank you.

TJ           Thank you, Shoko. Dr Rosamund Lewis will start.

RL          Thank you for the question on what measures the general public can take to protect themselves against monkeypox and also to help reduce and stop the outbreak of monkeypox. The most important thing is to appreciate one’s own level of risk, to understand and to seek out information from reputable sources, from health agencies and from community organisations that are sharing correct information about how monkeypox transmits and about who is at risk. The most important thing is to really seek out what are the choices that we can make that reduce our own level of risk.

00:14:17

At the moment, the people who are most at risk at this time are men who have sex with men in most countries in the world, not all countries, which is why it is also very important to pay attention to what is happening in your local region, in your city, in your country, in your area and to reduce your own risk. This may include, of course, sharing good information and also reducing the number of sexual partners, reducing the exposure in places that may put you at risk, such as crowded settings where lots of physical contact may take place among people who may be already at risk.

There are a number of things that can be done to reduce one’s own risk. If folks are going for a vaccine where it might be available, it is important to understand that the vaccine takes several weeks to take effect and to generate an immune response, which means that someone who is being vaccinated against monkeypox also has to continue taking protective measures and making safer choices during the time after the vaccine has been administered.

TJ           Thank you, Dr Lewis. Let’s go to the next question. We have Kai Kupferschmidt, from Science. Kai, please unmute yourself.

KK         Thanks a lot, Tarik. Thanks for taking the question. Two really quick ones. If feels like this is the first time that you’ve explicitly said that reducing the number of sexual contacts might be a good strategy at the moment to reduce the spread. I'm wondering whether you can elaborate a little bit on how countries should handle this and what we can actually do to get the information out.

00:16:00

Also, we do know, from a lot of history that changing behaviour, especially around sex, is really difficult and with the vaccine not becoming available very soon, I wonder how longer this can be kept up, even if people really want to do this.

TJ           Thanks, Kai. Do we have Mr Andy Seale online, who would maybe start with this? Andy, did you hear the question?

AS          Yes. And thank you, Kai, for the question. Hello to everybody. Perhaps, I can start. It’s a great question. I think there is lot of learning from HIV, as you suggest in your question. I think it’s one message within a package of prevention messages that needs to get through to people and we need to take a lead from how communities are also handling messaging here.

I think, for example, we’ve set up a community reference group that has already met four times including representatives from all WHO regions and they are also sharing with us strategies that are being led from communities, and this messaging around reduced partners is coming from the communities, themselves.

Clearly, this is, as you also suggest, potentially a short-term message. We hope that the outbreak, of course, will be short-lived. We hope that the other preventive measures in place will also support the outbreak to be contained quickly. I think the other messages that complement this are being very alert to symptoms, understanding what symptoms that people should look for if they think that they have been at risk, and seeking medical advice rapidly should they identify the fact that they may have symptoms.

00:17:45

So, rapidly excluding themselves from sexual contact, close social contact in that case is probably one of the most critical messages as well. We are also hearing from communities that advice around and support to, obviously, those who have been infected is critical. Really focusing on stigma and discrimination quite broadly as well will be critical in getting the outbreak under control.

But I think the reduction of sexual partners is an important message for now. We’re taking a lead from communities on how to message this and if you heard when the DG spoke, he also recognised that where people do have new partners, make sure you’ve got the contact details so that follow-up can be organised should that be required, should somebody develop monkeypox. Thanks.

TJ           Thank you, Andy. I hope this answers the question. So, we can go to the next one and that is Helen Branswell, from STAT. Helen.

HB         Hi. Thanks for taking my question, Tarik. I want to switch gears from monkeypox to Marburg. On Friday, WHO sent out a DON saying that all of the contacts of the two Marburg cases in Ghana had been through their 21 days of monitoring and none had developed symptoms, but we’ve since heard that there have been two additional cases, people who had been contacts of the first case. So, I’m a bit confused about what is going on there. Can you please give us an update on what is going on in Ghana?

00:19:29

TJ           Thank you, Helen. We will go to Dr Fall, if he is with us. Dr Fall, could you please take this question?

SF          Thank you, Tarik. Can you hear me?

TJ           Very well.

SF          Thank you, Helen. You are right. We have two additional cases of Marburg in Ghana. The first one is the wife in this case and the child in this case as well. This is information we received from the country. They have talked about 180 contact follow-ups but we still additional contacts related to the last cases. There are more than 40. It means that all contacts are not out of the risk period.

So, the teams are working to investigate, to understand better how these people were infected. Apparently, the child was infected by the mother, not by index case. That is why it is really important to continue making sure that we have thorough investigation and making sure that all contacts are followed up. This is extremely important because, depending on the quality of the investigation, the ability to isolate contacts is important to stop the transmission and we are still having a challenge because the wife of the index case is still in a kind of prayer camp and the teams are working with the community to be able to isolate her.

00:21:08

The situation is still very difficult because you have three regions affected right now. Although the number of cases is not high at the moment, we need to make sure that every hotspot can be stopped otherwise it will become more complex. So, we are working very closely with the country, with partners to make sure that we can stop it as soon as possible. Thank you.

TJ           Many thanks, Dr Fall. I understand that Dr Ana Maria Restrepo may had something on the Marburg research for vaccines and therapeutics. Dr Henao-Restrepo.

AR          Thank you, Tarik. We have been working with colleagues and researchers and developers for over a year now in a consortium called Marburg. As part of this research preparedness effort, we have now identified all the candidate vaccines and candidate therapeutics for Marburg and we have been working in close collaboration with the developers.

In addition to that, in collaboration with NIAID, NIH and many other research centres around the world, we are in the process of finalising protocols for the evaluation of these vaccines and therapeutics. We anticipate that by the end of next week we can have a protocol that could be presented to the national authorities in Ghana for consideration.

We think that this is a good example of how research preparedness pays off because before the outbreak we already have the landscape of the medical countermeasures that could be used and the alliance of the protocols and how to evaluate, and a very good collaboration from the scientific community. So, we are expecting to see this evolution of the outbreak but we are ready to evaluate the vaccines and therapeutics, if necessary. Thank you.

00:22:57

TJ           Thank you very much, Dr Ana Maria. We’ll got to the next question. That’s Max Kozlov, from Nature. Max, can you hear us? Unmute yourself, please.

MA         Hi. Thanks for taking my question. Around a month ago the DG supported changes to the naming of monkeypox or the different clades of monkeypox, and I was just wondering if there is any kind of movement on that or what next steps might look like and if it is too late now that there has been a public health emergency declared about it. Thank you.

TJ           Dr Lewis.

RL          Sure. Thank you. I am sure you’re aware that there are three different things. There is the name of the disease, the name of the virus, and the name of the clades. The name of the clades is something that scientists are already discussing through their research and in the scientific literature. Proposals are being made such as naming clades 1 and 2 for example, instead of using geographic-based names.

For virus, itself, the International Committee on the Taxonomy of Viruses has already embarked on conversations with their orthopoxvirus group on whether there will be any modifications to not only the name of the monkeypox virus but, of course, there are many other pox viruses that carry similar names that have been known for a long time.

00:24:19

So, that is up to the ICTV to provide a response to that and for WHO, our responsibility is the naming of the disease which has existed already in the international classification of diseases for some time. So, there is a process that we have initiated and welcome all proposals as to what the new name might be. Thank you.

TJ           Thank you, Dr Lewis. Dr Swaminathan, would you like to add something?

SS          Yes. Just to add, I think, to what Rosamund was saying, that the naming of diseases, there was a revised procedure that WHO adopted several years ago essentially to overcome the previous history of naming diseases by place of origin or where it was first detected or sometimes even a name of an individual, etc.

There are standard rules now on the naming of diseases and there is a call that has been put out, actually, for suggestions and then a committee will then consider those suggestions. So, we, as far as I know, have not received any proposals for a name to replace monkeypox. That process is still open and, as Rosamund said, we welcome any constructive suggestions. Thank you.

MR         Just to add, while all this is being done, for the vast majority of people who deal with these diseases, experience them in the communities, the name per se is not a major issue. It’s the weaponisation of these names. It’s the use of these names in the pejorative. It is the targeted manipulation of the implications of what these names make.

00:26:04

The names in themselves, the people of Marburg today in Germany, the virus Marburg we’re talking about now in Ghana is named after Marburg because it was first discovered in a lab there. All of those issues are around geographic representation but I don’t think the people of Marburg today are worried about the stigma of that per se.

But there are certain words and certain trigger words that are then used and manipulated in other circumstances and they are basically, frankly, racist connotations that come from some of this and we have to call that out because names are names. No matter what names we use, if people are determined to misuse and to weaponise names in order to isolate or discriminate or stigmatise people, then that will always continue.

We will do as Soumya said and I think the international scientific community has a job of work to do to the extent possible to take those opportunities away. But that, in itself, is not the problem. The problem is the misuse of these terminologies around the world, especially when they implicate racial slurs.

TJ           Thank you. We will go the next question and just to say that we got a question from Simon Martin, from Radio France, exactly on this. So, I hope, Simon, you got the answer in previous interventions. Let’s got to NBC, and we have Ben Ryan.

00:27:40

BR         Hi. Thanks for taking my question. As you know, there was a pre-print suggested that the R0 for monkeypox might only be over 1 for men who have sex with men, meaning that at-risk group could possibly be the only one to have an average transmission of more than one person in each case. I was wondering if you could speak to that and the quality of risk for non-MSM, including women and children, if there is any qualitative words you might want to apply to their risk at this time and looking forward.

TJ           Dr Lewis.

RL          Thank you, Mr Ryan. Yes, you’ve indicated correctly that there is some suggestion, some modelling and some publications are finding that R0 might be 1.6, 1.7, 1.8 in some European countries where, as the Director-General has already indicated, 99% of cases are still among men and, of those, over 95-98% are among men who have sex with men.

The R0 is a property of the transmission of the virus and also the circumstances in which the virus might be transmitted and it is a property when there is no intervention. So, if there is no intervention in a circumstance where there is a lot of skin-to-skin contact, frequent contact on a regular basis, perhaps in the context of multiple partnerships or contact with anonymous partners, then that would be a circumstance without intervention where the virus can spread more easily.

Monkeypox virus has been known in the past to have an R0 just under 1, which is why in the past the outbreaks have been self-contained, generally self-limited and shorter chains of transmission. This may be changing now also because of the lack of global immunity to orthopoxviruses in general, providing a larger pool of susceptible individuals who, once exposed, may contract infection through lack of immunity.

00:29:41

I think the message the comes here is that it is important to continue to emphasise the choices that individuals can make to protect themselves. If the R0 remains less than 1 for most people then the outbreak, itself, will be self-limited, so that is a very important feature.

You did ask directly about risk for women, children and others who may be exposed. We know very clearly that one of the main modes of exposure for this particular illness is through direct contact, close contact, skin-to-skin contact, possibly even face-to-face contact, exposure to droplets or a virus that may be in the mouth. Many people have lesions in the mouth.

So, it is very important for anyone who has monkeypox to isolate so that they can protect also anyone else living in their household or anyone else that they may be in contact with. Household transmission is how this was first discovered and household transmission also may, in some circumstances, begin to occur now and so it is critically important that everyone understand that this is a disease that transmits through close contact and to make the choices that need to be made accordingly to protect themselves and other people.

00:30:56

MK         Thanks. I just wanted to comment on the concept of the reproduction number because we have such an educated public now, given the last couple of years that we’ve had for COVID-19. Rosamund, completely has provided an answer to that but I just wanted to comment that this reproduction number is an average. It’s the average number someone who is infected can pass the virus to someone else in a susceptible population. It is an average, which means some people may have more than that and some people may have less that.

Any R0 above 1 means an epidemic can take off and, as you’ve pointed out, we have one particular population, communities of men having sex with men where the R0 has been estimated to be over 1. That means the outbreak is expanding and that means there are opportunities to bring that reproduction number below one.

All of the ways in which Rosamund and Andy have outlined and the Director-General has outlined, ways to reduce the risk, to reduce onward spread because monkeypox is different than COVID. You need that direct, physical, skin-to-skin, mouth-to-skin contact, as has been described. There are many ways in which that risk can be reduced.

There is an opportunity to bring the R0, to bring that reproduction number below 1 in MSM communities with the right information by empowering this community, activating this community to take control of the situation so that this outbreak of monkeypox in MSM right now can be brought under 1.

00:32:22

TJ           Many thanks. Now, we will move to AFP, Nina Larson. Nina.

NL          Hi. Thank you for taking my question. I wanted to ask about the two new peer-reviewed studies published in Science this week that claim that the animal market in Wuhan was really the epicentre of the COVID pandemic and basically ruling out the lab leak theory. I’m wondering how credible you think these studies are and if they will or should alter the approach to investigating the COVID origins.

I also just had a clarification to ask you about the previous answers. When talking about reducing sexual partners, my understanding is that monkeypox is spread through close contact but not necessarily sexual transmission. Could you just clarify if there is sexual transmission? Thank you.

TJ           Thank you. Let’s start with the first question with Dr Van Kerkhove.

MK         Thanks, Nina, for the question. These two papers that have been published were actually available as pre-prints a few months ago. WHO, our internal secretariat evaluated them, as did the SAGO, the Scientific Advisory Group for the Origins of Novel Pathogens, evaluated these papers as they have done with all of the papers that are currently available, looking at how the COVID-19 pandemic began.

These are good analyses that have looked at all available data, that is looking at the early cases, looking at where those cases occurred, the geographic distribution in space and in time, in looking at different exposures. There’s another paper that looked at the genetic sequences that became available and looked at the potential for spillover events that occurred in that market. Then, there was a third paper, which you didn’t mention, but there is a third paper looking at environment samples.

00:34:19

So we, as WHO and the SAGO were aware of this data as pre-prints and even before because a lot of this was discussed and outlined in the March 2021 report of the WHO joint mission and this gives further information about what happened early on in the pandemic, in December of 2019, in early January 2020.

It provides additional information that we have that is available but, for us, what is really critical and what critically remains is looking further within China, further within Wuhan and in the markets within Wuhan, about further serologic studies in the markets themselves, for example, among people who were exposed to animals that we know are susceptible to SARS-CoV-2, to look at where the animals that were sold at those markets came from.

So, tracing back those animals to those source farms and looking to see what were the species that were sold, and if any specimens remain, to test those samples to see if there is any evidence of SARS-CoV-2 infection or antibodies, and then looking at the people that worked at those source farms.

For us, this does provide more information around what was happening early days but unfortunately it is not enough. We need more studies to be done in China and elsewhere to really understand the earliest stages. Without those serologic studies in the markets, at the source farms, without tracing those animals back, it still leaves some open questions for us.

00:35:49

But they are good pieces of work. We welcome more scientific studies, peer reviewed scientific studies to help us get closer to understanding how this pandemic began. Remember, the goal is not just to figure out how this pandemic began, it’s to learn how we better prepare for the future. So, that work will continue because we will continue to have spillover events.

We see this with even monkeypox. We see additional spillover that’s happening in a number of countries. We see this with Marburg. We see this with a lot of pathogens with epidemic and pandemic potential. The goal is to learn. The goal is not to blame. The goal is to learn and to take those learnings to be better prepared.

So, the work of WHO continues. The work in countries for the studies that have been recommended by the SAGO continues. We, as the secretariat, will continue to work with all countries to better understand and to further understand the start of this pandemic.

MR         Just briefly to add that, like in all situations of origins, this is a scientific detective story that goes on and each new piece of information adds to the overall assessment and a new piece of information or new scientific studies can move more positively with one hypothesis or another but, like all stories like that, all hypotheses remain on the table until you can prove that one hypothesis is the explanatory hypothesis. So, it is important for us to remember that all hypotheses remain on the table but we’re very pleased to see this kind of work being done which advances us and advances our common understanding of the origins of this disease.

00:37:26

TJ           Thank you, Dr Ryan and Dr Van Kerkhove. Mr Seale, would you like to take this second question that was on the transmission mode?

AS          Tarik, could you please remind me of the exact wording? Thank you, and I will be happy to.

TJ           Now, if I remember correctly the question that came, it was the transmission mode of monkeypox, is it a sexually transmitted disease? Is it close contact transmission? There is a need for clarification on that.

AS          Thank you. We have convened a number of STI experts to look into this question and, in short, they’ve concluded that this is clearly transmitted during sex and so they’re comfortable in describing this as sexually transmissible but they have not yet felt able to reach a conclusion to state that this is an STI.

So, they’re looking at past experiences where there are multiple modes of transmission, including Zika, for example, and they’re comparing different experiences from those types of experience. They’re looking at lab data around presence in vaginal fluids and semen, of course, of the virus.

In terms of messaging, the one area where we might instinctively assume that we would be able to confidently say use condoms as a level of protection, we’re not able to do that for monkeypox, just because we know that it is that close skin-to-skin contact, that that facilitates transmission, a little bit like herpes. Condoms aren’t efficient in protecting herpes transmission, but other STIs they are.

00:39:13

So, I think the critical piece is really focusing in on close intimate personal contact, prolonged contact that happens during sex as the key mode of transmission and obviously, as others have said, we continue to interrogate the data. Thank you, Tarik.

RL          Thanks very much, Andy. Nina, just to come back to your original question and just to confirm and, of course, endorse what Andy has said but also to confirm what you suggested. Yes, it is close contact. There are other modes of transmission. Not necessarily sexual transmission is required, so close contact of skin-to-skin, which is why health agencies are also sharing the information that while one group are predominantly affected and greatly affected at the moment, it is very important for all of us to appreciate that anyone can be at risk.

It’s a very difficult message to put across. There is one group that is primarily at risk at the moment and this is the group that we really want to get information to on how to protect themselves, but at the same time anyone who is exposed to monkeypox can also be exposed. While the risk to the general public is at the moment not as great, it is important that we also share the message that it is possible to be exposed in a setting where there are many people together with physical contact and that includes a household setting. So, some people are being exposed in a household setting, both in countries where this disease has long been known as well as, now, in newly affected countries.

00:41:05

SS          Tarik?

TJ           Dr Swaminathan, would you like to add something to this?

SS          Just a very quick point on transmission. We’ve seen that in some countries the Bavarian Nordic vaccine has been made available to some high risk groups and also to those who have been exposed as a sort of post-exposure prophylaxis. I think it’s important to remember that, firstly, we don’t have the full clinical effectiveness data on this vaccine because the vaccines that we have today were developed for smallpox and we believe that they would work against monkeypox but those studies need to be done and the data needs to be collected.

But also it takes time to develop an immune response and the JYNNEOS vaccine, which is the Bavarian Nordic one that has been approved now in the EMA, FDA and Canada, is a two-dose vaccine and it takes a couple of weeks after the second dose to really achieve full immunity. That is what the company says.

Therefore, one is not protected a few days after taking the vaccine, so this is why, again, to highlight that the safe behaviour practices are really going to be very, very critical and in fact that is most important right now in reducing the transmission of this infection from person-to-person. The vaccine could be an add-on tool that might help but at the moment we don’t have the data to confidently say that the vaccine is the best approach to this outbreak.

00:42:35

MR         I think Soumya makes a really important point because it is a bit like with COVID. Dr Tedros was saying from the very beginning of COVID, we need comprehensive, inclusive strategies that focus on all elements of this, on awareness, on diagnosis, on health-seeking behaviour, on risk reduction, on preventing onward transmission.

We’re seeing benefits of that now in communities where we see open, transparent communication and good dialogue between governments and affected communities. We’re beginning to see positive signs. There’s no silver bullets here and we have to be very careful. Vaccines are for hope in every situation but vaccines by themselves, right now are not a silver bullet.

This is not a situation where vaccines replace everything else. Vaccines will come into play in very specific situations and may become very important. Right now, there are uncertainties around that. There are issues around how long it take to be protected when you’re vaccinated. Who should be vaccinated? What is the efficacy of these vaccines? What are the effective strategies? Is it focusing on contacts or focusing on risk groups?

There are unknowns here and the scientific community is working extremely well. Dr Tedros has had very high level phone calls with other leaders of agencies like Gavi and CEPI and UNICEF to look at this at the highest level to see how best we move forward strategically. And there is great hope in that and, Soumya, you’ve also said that we need short, medium and long-term strategies here for these vaccines because there is an endemic situation with monkeypox as well.

00:44:06

Dealing with this outbreak alone, we need to deal with the long-term issues of countries that have been affected for decades by this disease. So, taking a comprehensive, long-term approach to this, identifying what we can do now to bring vaccines into play as part of a comprehensive strategy has to be our way forward.

Again, because of these uncertainties around what we don’t know, it’s really important we collect data along the way. This is one of these situations. We’re collecting randomised evidence where we can to ensure that we fully understand how efficacious these vaccines are and what strategies will give us the best outcomes for the populations that we’re serving.

TJ           Thank you, all. We have a number of questions and I’m afraid we probably will not be able to answer all of them but let’s take one or two more. We have Ömer Yildiz, from Anadolu News Agency. Ömer, please unmute yourself.

OY          Hi. Thanks for taking my question. My question is about vaccinations, actually, and actually Dr Ryan told us about the special circumstances. My point is given the current rise in the cases, when actually can we expect a mass vaccination campaign at international level? Thank you.

00:45:37

TJ           Dr Lewis, please.

RL          Thank you very much. The WHO interim guidance is online. It has been online since 14 June, I believe and it clearly states, as Dr Tedros also stated this afternoon, that mass vaccination is not recommended at this time. This is a virus which is at the moment affecting a specific group of people and there are behavioural interventions that are effective. Vaccine may also be effective based on prior experience but we don’t have effectiveness data for monkeypox in this type of outbreak at this time.

So, we are strongly encouraging all countries and all parties to undertake studies to collect data on effectiveness and safety of this vaccine, even as they are rolling it out where it can be rolled out for persons who are contacts who may have been exposed or for persons who may be at high risk for different reasons.

At this time there is no indication of a need for mass vaccination. Of course, we remain open to how this outbreak will evolve. We hope it will not evolve. We hope we are still able to stop this outbreak through the combination of measures that are available, surveillance, contact tracing, isolation of cases, monitoring of contacts who need to monitor themselves for fever or development of other symptoms such as a rash.

Risk communication, community engagement, particularly engaging with associations and individuals who are themselves at high risk at the moment, seeking out support from community leaders and influencers and, of course, the entire package of interventions as has been outlined in the temporary recommendations that the Director-General has issued on Saturday for all Member States and all stakeholders in responding to this outbreak.

00:47:37

TJ           Thank you, Dr Lewis. Let’s try to take Sara Jerving, from Devex. Sara, please unmute yourself.

SJ           Thank you so much. Today, the MedAccess and the Clinton Global Health Initiative announced that they negotiated a price of $1.00 per HIV self-test. Do you think that price is low enough to increase access broadly enough? Thank you.

TJ           Thank you. Andy, would you like to try to answer this question?

AS          Thank you, Tarik, and thank you for the question, Sara. I’m actually in Montreal at the moment at the International AIDS Conference and that announcement was being made in the context of the conference. I have colleagues involved literally now in that conference who could be better placed to answer your question.

In short, we are very happy with this reduction and we see this as a positive way forward and we’re promoting it appropriately through our websites. Of course, communities and others will have their own perspectives and we work in collaboration always, including with manufacturers, to achieve the best ways forward to get optimal access. Thanks.

TJ           Thank you, Andy, very much for this. Let’s try to take as many questions as we can. Let’s try with The Wall Street Journal. We have Denise Roland with us. Denise.

00:49:09

DR         Hi. Thanks for taking my question. I’ve got two on monkeypox. In this narrower group of people who should be targeted for vaccination, this high risk group for exposure, what is your best estimate for the number of people in that group? In other words how many doses does the world need to vaccinate all the people at high risk of exposure in this narrower way, short of a mass vaccination campaign? Secondly, is any action underway to expand the manufacture of MVA-BN, either by speeding up the fill and finish of bulk or making more bulk vaccine? Thank you.

TJ           Thank you. Let’s got to Mr Tim Nguyen. Tim.

TN          Thank you, Denise. WHO has currently activated our infectious disease modelling network to look exactly at these questions about the global need to serve different intervention strategies including different forms for vaccination strategies. As we are looking and gearing towards the result of this expert consultation we do some ballpark estimation on some of these needs to help guide us with our next steps in our planning process.

If you look at a post-exposure vaccination strategy, basically what we do is extrapolate the number of global cases and multiply by ten to 20 contacts each of these cases have. In this context, we are looking right at 18,000 cases, so this translates into 180,000-360,000 vaccine doses for such a strategy.

00:50:57

When you’re looking at pre-exposure prophylaxis, and depending on what countries define as high risk groups, including MSM population with high risk behaviour, this could account to currently, for the 78 countries that are reporting cases, to something between five to ten million doses of vaccine. These is a very preliminary, ballpark estimation and we’re looking further to the modelling studies that we have been commissioning.

Now, when it comes to the supply situation, with that later strategy, we know at the moment if we do this nowcasting there is not enough vaccine in fill and finish form to serve such a strategy in the current context. So, the key and I think that’s what your question has been gearing up to, is how fast can the turn of bulk into fill and finish happen?

This is where we are in constant discussion with manufacturers on expanding what are their plans in terms of fill and finish capacity. Our understanding, this is now gearing up on the manufacturing side. Here, in WHO, we have received offers from different manufacturers to support that fill and finish capacity and that’s based on the WHO and the DG call for those intensified actions to happen after the declaration of the public health emergency of international concern. So, this is where we’re trying to match those offers that are coming in and providing these offers also to the current manufacturing capacity. Thank you.

TJ           Dr Swaminathan, would you like to add?

00:52:57

SS          Very quickly. I think Tim has covered most of it but we are in discussions with the manufacturers to do a couple of things. The first one is to get an idea of the availability of doses, the finished ones that can be used immediately. Many of them have been committed to countries already, as countries are purchasing these doses from the companies.

We would also like to explore the possibility of a donation from the countries that have already booked or purchased doses so that they could be put into a stockpile for countries that do not have currently any access to vaccines and also for research use because, as I said earlier, there is a need to generate data.

Then, the second one we’re exploring is on the fill and finish because Bavarian Nordic has bulk and it would be maybe possible to get some other companies to support them in the fill and finish process Then, the third is the longer-term needs particularly for the countries where monkeypox has been spreading for the last several decades, where a vaccination strategy again is being thought about.

Again, it needs more thinking, it needs more data, it needs more research, it needs better surveillance but in the case that such a vaccine may be used in the population we will need then to think about technology transfer, manufacturing on a wider scale and this is where, again, the whole initiative of technology transfer, of distributed manufacturing, of enabling local manufacturers to produce vaccines for endemic disease and also bringing the cost down to make it more affordable and accessible.

00:54:41

I think this is a test, again, for some of the lessons we learned from COVID. Monkeypox right now, luckily, is not killing people but we don’t know. We have to prepare for the future, for this and other pathogens, and this is where we have an opportunity to look at how R&D and manufacturing, particularly for these pathogens which can cause sudden epidemics and pandemics. How does the world actually work together to address a situation where there is shortage, limited supplies and the demand may actually outstrip the supplies very quickly? Thank you.

TJ           Thank you, Dr Swaminathan. Let’s move on. We have Erin Prater, from Fortune. Erin, can you please unmute yourself.

EP          Thank you so much for taking my question. I’m just curious if there has been any kind of update in the evolution of the monkeypox virus. I believe several weeks ago CDC officials said that at least two different strains of the West African clade had been identified in the US. Any update on that? Thank you.

TJ           Who would like? Maybe Dr Lewis can start.

RL          Sure. Indeed, there are a couple of studies coming out now. There was another one this week. These are very early days yet for these types of studies. The clades of the viruses, as you know, go back many years, go back 70 years, and then the West African clade or clade 2 has always been there but has appeared more frequently since 2017. But there are extended gaps, both in the timeframes during which sequencing was done as well as there are many, perhaps, sequences there that are not yet available.

00:56:31

We clearly see that there has been some evolution but we don’t yet know what it means in terms of transmissibility, we don’t yet know what it means in terms of how the disease manifests when someone is infected with the virus. However, what we can certainly say is that the longer the virus continues to circulate the more opportunity it does have to continue to be modified or to mutate and to develop new genotypic or phenotypic features.

Again, it is critically important to slow down this spread for that reason, as well as any other reason of protecting people and communities but also, as we still don’t know a lot about what this virus is doing right now, it’s another reason to really make every effort to stop the outbreak because as long as it continues to spread it will have further opportunities to adapt to the human population.

MR         And just maybe to build on that point and the point that Soumya made. We do have to break this cycle of having these reactive approaches to the emergence of these diseases in new populations. Many, many people, Rosamund and many others work in WHO and in many scientific institutions around the world and they work on these diseases over decades and they maintain a body of knowledge. And they struggle to get research money, they struggle to get the necessary resources.

Manufacturers have big costs in developing these niche products because they have to go through the whole process for what is a product that may not have a big market. So, there are real deficits in how we’re looking at this in terms of scanning the horizon and seeing the risks before it comes over the hill.

00:58:17

Now, we’re reacting when the problem is amongst us and causing major problems. That’s when we end up having to scramble collectively, scramble scientifically, scramble from a manufacturing point of view, scramble from a communications point of view. We need to stop scrambling so much. We need to be in a much stronger position with poxviruses, flu viruses, coronaviruses, filoviruses.

Soumya will be repeating our pathogen prioritisation process in the coming months. We need to take this seriously. When we sit together as a global community and we prioritise pathogens for the future, that is not just about waving a flag. That is about investing up front in the science, in the research, in building countermeasures.

It will cost money and it does cost money, but it is a fantastic investment in protecting us down the line and a dollar spent on preparedness is worth a thousand dollars spent on response. I think we need to really take a much more systematic look at how we prioritise pathogens for the future and then how we invest, so when these things come along we’re not having to deal with limited availability of diagnostics, limited availability of antivirals, limited availability of vaccines, because this will just repeat, repeat and we will live/die repeat on this unless we take control.

And I believe we have, for the first time in human history, the science and the cohesion, I hope, to take these things more seriously, more systematically and we need decades of run-up to many of these diseases in order to have the necessary countermeasures in place. Dr Tedros has called for this in pandemic preparedness and response, to really get the focus on preparing, on being ready.

01:00:05

Yes, continuing to respond well but continuing to respond well to these events, making up for gaps that exist, systematic gaps and weaknesses in our health system, systematic gaps in our diagnostics, systematic gaps in our manufacturing capacity, systematic gaps on our fairness and equity. These will just continue to repeat themselves.

So, I do think, as we sit today with COVID, with monkeypox, with Marburg, with polio, we need to realise that this is not stopping and we need to be much more considered, measured and strategic in our approach. This is what Tedros has been calling for. He’s been calling for this for a very long time, long before COVID came and it is time for us all to be much more directed and systematic in how we deal with these diseases.

TJ           Thank you. Thank you, Dr Ryan. Maybe we will take one last question. We are already beyond the hour and there are still many questions but I will invite all those whose questions we didn’t have the time to answer to come to the media team and we will try to answer each one of them. Let’s go to Gabriela Sotomayor, from Proceso, for the last question today. Gabriela.

01:01:24

GS         Hola. Thank you. Thank you very much for taking my question. What are your main concerns regarding monkeypox in children? I understand that the disease can be very serious for them. Then, a question for Dr Tedros. What do you recommend to countries from Latin America, for example like Mexico, with few cases? The outbreak is being underestimated, which is not even remotely like COVID. There is no comparison but Mexico is one of the countries with one of the highest number of deaths because they did not take COVID seriously. So, what is Dr Tedros’ recommendation in these countries? Thank you.

TJ           Thank you, Gabriela. We will try to answer the question about children first. Dr Lewis.

RL          Thank you, Gabriela. What we’ve known from monkeypox research in the past is that children are at higher risk of severe disease. That does mean that every child that contracts a monkeypox virus infection will develop severe disease. There is, of course, a range of clinical manifestations like there are with most infectious diseases. However, it does mean that there is a preponderance of children, pregnant women and immune compromised persons amongst those who do develop severe disease.

So, for example if the rash is very extensive there can be fluid loss, so the child can become dehydrated. Also you know that the lymph nodes predominantly, often in both the classic and the current forms that we’re seeing appear on the neck and these lymph nodes, can become significantly enlarged and make it difficult to swallow, which also can contribute to dehydration.

01:03:10

There can be severe pain in the mouth and throat which contributes to difficulty eating. So, maintaining hydration, nutritional status is really critically important for children who do become quite ill. Taking care of the rash is important for children who develop significant rash and, of course, monkeypox can also affect the other mucosal surfaces, especially and including the eyes. Certainly, in the African setting we’ve seen a number of people who develop scarring over the cornea and become blind due to monkeypox because of the lesions that appear in the eyes and on the cornea.

There are number of other things that can happen. We’re starting to see a few cases of encephalitis, which is inflammation of the brain. This has been reported in the past. We want to do everything we can to keep everyone safe, of course, but a young child or pregnant woman may also have consequences that are through having the virus during pregnancy.

These are people who are vulnerable, either because of their particular age, their status. Children are still building their immunity and others may have their immunity compromised, whether through pregnancy, whether through untreated HIV, whether through chemotherapy, whether through other immunosuppressive treatments. So, these are some of things that we look for and these are some of things that we want to guard against and protect vulnerable people during this outbreak. Over to you, Mike.

01:04:44

TJ           Dr Ryan.

MR         Just briefly. You’re correct. This is not COVID. Monkeypox is not COVID but it is still a serious event that requires scaled-up and intensified action because we don’t know the future and there are enough uncertainties here and this is deeply affecting one very important part of our community as well and we need to show that solidarity that we would expect to be shown to all parts of our communities, and Dr Tedros has called on this.

We’ve maintained, under Dr Tedros’ leadership, activities on monkeypox and smallpox before, right they way through COVID, through the leadership of people like Rosamund here, keeping scientific committees working, keeping the research community moving on this process.

Secondly, when Dr Tedros called the committee together for the first time, he was reaching out and alerting the world that this is a problem, it’s on the table and we’re looking at it closely. Bringing the committee back together again and then issuing his declaration of a PHEIC is a call to action and it is a call specifically to action by Member States all over the world.

With specific reference to Mexico, many countries have had the good and the bad of COVID. No country can stand up and say we’ve been perfect and no country is in a situation where it did everything terribly. We all struggle collectively to meet the challenge that COVID has brought to our communities.

So, from that perspective, I think Dr Tedros is saying to every country, including Mexico, monkeypox is an issue. It requires intensified, coordinated response. It requires us to beef up diagnostics, surveillance and, most importantly, open, transparent, sensitive communications with all parts of our community. This is the way for this disease to be contained and controlled. That needs to happen everywhere in every country, including Mexico.

01:06:47

TJ           Thank you very much, Dr Lewis and Dr Ryan, for answering this last question for today. We will send audio and video files of this press briefing, and hopefully the transcript will be available tomorrow. With this, I will give the floor to Dr Tedros for his closing remarks.

TAG        Thank you. Thank you, Tarik. I would like to thank all colleagues from the press who have joined today and see you next time.