WHO press conference on coronavirus disease (COVID-19) - 8 February
00:00:37
FC Hello
everyone. I am Fadela Chaib, speaking to you from WHO headquarters in Geneva
and welcoming you to our global COVID-19 press conference today, Monday 8th
February. I would like to start this press conference by sending my apologies
for the delay in starting this press conference. Sorry for that. We will have
three special guests today, whom Dr Tedros will introduce shortly. We have
simultaneous interpretation in the six official UN languages plus Portuguese
and Hindi. Let me introduce to you the WHO participants.
Present in the room are WHO Director-General, Dr
Tedros, Dr Mike Ryan, Executive Director, Health Emergencies Programme, Dr
Maria Van Kerkhove, Technical Lead for COVID-19, Dr Mariangela Simao, Assistant
Director-General for Access to Medicines and Health Products, Dr Soumya
Swaminathan, Chief Scientist, Dr Bruce Aylward, Special Advisor to the Director-General
and lead on the ACT Accelerator and Dr Kate O'Brien, Director, Immunisation,
Vaccines and Biologicals. Welcome, all.
Now without further ado I will hand over to Dr
Tedros for his opening remarks and to introduce our three guests. Over to you,
Dr Tedros.
TAG Thank
you. Thank you, Fadela. First of all I would like to apologise; sorry for
keeping you waiting. We had a meeting that took longer than we expected, many
of my colleagues here and myself so apologies for that.
00:02:18
Good morning, good afternoon and good evening.
Yesterday a new case of Ebola was reported near the city of Butembo in the
Democratic Republic of the Congo. Butembo is in the North Kivu province where a
previous outbreak was declared over in June last year. The woman who sadly has
died was married to an Ebola survivor.
Thanks to the enormous capacity built during the
latest outbreak provincial health authorities have significant experience in
responding to Ebola and in preventing onward transmission. More than 70
contacts have been identified and WHO is supporting local and national
authorities to trace them and provide care where needed.
So far no other cases have been identified but
it's possible there will be further cases because the woman had contact with
many people after she became symptomatic.
00:03:27
Vaccines are being sent to the area and we hope
that vaccination will start as soon as possible. WHO has sent a rapid response
team to provide support as needed.
The Oxford AstraZeneca vaccine is one of several
that have been shown to be effective in preventing severe disease,
hospitalisation and death from COVID-19. The emergence of new variants of the
virus has raised questions about the potential impact of those variants on
vaccines.
Yesterday South Africa announced that it was
putting a temporary hold on the roll-out of the Oxford AstraZeneca vaccine
after a study showed it was minimally effective at preventing mild to moderate
disease caused by a variant first identified in South Africa.
This is clearly concerning news. However there
are some important caveats. Given the limited sample size of the trial and the
younger, healthier profile of the participants it's important to determine
whether or not the vaccine remains effective in preventing more severe illness.
These results are a reminder that we need to to
everything we can to reduce circulation of the virus with proven public health
measures. Several countries are succeeding in suppressing transmission,
including those where new variants are circulating.
00:05:08
We all have a role to play in protecting
vaccines. Every time you decide to stay at home, to avoid crowds, to wear a
mask or to clean your hands you're denying the virus the opportunity to spread
and the opportunity to change in ways that could make vaccines less effective.
It also seems increasingly clear that
manufacturers will have to adjust to the evolution of the virus, taking into
account the latest variants for future shots including boosters. We know
viruses mutate and we know we have to be ready to adapt vaccines so they remain
effective.
This is what happens with flu vaccines, which
are updated twice a year to match the dominant strains. WHO has an existing
mechanism for tracking and evaluating variants of the virus that causes
COVID-19. It's vital that countries continue to report these variants to WHO so
we can co-ordinate global efforts to monitor their impact and advise countries
accordingly.
00:06:22
We're now expanding that mechanism to provide
guidance to manufacturers and countries on changes that may be needed for
vaccines. These developments highlight why it's so important to scale up
manufacturing and roll out vaccines as quickly as possible and as widely as
possible to protect people before they're exposed to new variants.
We also need to continue designing and
conducting new trials and we need to keep a close eye on the impact vaccines
are having on epidemiology, severe disease and death so we can use vaccines to
maximal effect. WHO's Strategic Advisory Group of Experts on Immunisation or
SAGE has met today to review the Oxford AstraZeneca vaccine and to discuss
these new developments. Tomorrow I will meet with the Chair of the SAGE to
discuss its recommendations.
To say more about the new study in South Africa
and its implications I'm pleased to welcome Professor Salim Abdool Karim, the
Co-Chair of South Africa's Ministerial Advisory Committee on COVID-19.
Professor Abdool Karim, thank you for joining us today and you have the floor.
00:07:47
SAK Thank
you very much, Dr Tedros. It's indeed a pleasure and an honour to be here with
you. I'll just briefly share with you the reasons behind the South African
decision and how we are viewing the situation.
Put very simply, we have been monitoring how the
different vaccines are stacking up in terms of their laboratory assays, whether
they're tested in a pseudo [unclear] assay or in a live virus plaque assay. To
day five of the eight vaccines that we've been monitoring have had these
laboratory assays.
What they show is that vaccine-induced
antibodies have greater difficulty neutralising the 501YV2 variant than they
have against pre-existing variants. We saw substantial declines in some
vaccines and less so in others so for example with Pfizer and the Sinopharm
vaccines we saw minimal reduction in the potency of the antibodies and minimal
changes in neutralisation activity.
However with other vaccines such as the
AstraZeneca vaccine we saw very substantial reductions in neutralising
activity. We don't fully understand what those laboratory results mean so we
need clinical data. Fortunately three of the vaccines have been tested in South
Africa where the 501YV2 variant constitutes about 80 to 90% of the circulating
viruses.
00:09:29
The first results that we heard were from a
vaccine produced by Novovax and there we heard quite concerningly that the
efficacy of the vaccine was 89% in the UK but only 49% in South Africa. That
was the first indication that efficacy levels would be diminished in addressing
the 501YV2 variant.
Most recently we saw this week the release of a
study; it's quite a small study with 2,026 participants, largely young
individuals and one of the important things is that the trial used a dosing
interval that is quite short compared to the newer, longer intervals that are
being proposed by AstraZeneca.
So looking at that what was shown was that while
the overall efficacy of the AstraZeneca vaccine was 66% in the largest study
that included the UK, Brazil and South Africa, the South African data on its
own showed only 22% efficacy. It should be noted it has a very wide confidence
interval that includes even 60% protection in that confidence interval.
But that study which looked at only mild and
moderate infections raised concerns, not because we were not expecting some diminishing
activity but it was the level to which it was diminished. So now we are unclear
and uncertain about the efficacy of the vaccine in preventing hospitalisation
and severe disease.
00:11:13
We know from the overall trial that the
AstraZeneca vaccine is effective against other pre-existing variants. We're
just not confident about its efficacy against the 501YV2 variant and so we've
proposed an alternative approach, a new approach to the way in which we roll
out the vaccine.
One proposal that's currently being considered
is to roll it out initially just in a stepped manner where the first step
includes about 100,000 individuals that are vaccinated in which we monitor the
hospitalisation rates. If they are below the threshold that we're looking for
then we're confident that the vaccine is effective in preventing
hospitalisation and then we can roll it out. Alternatively if it's above that
threshold then we need to look at alternatives.
So put very simply, we don't want to end up with
a situation where we've vaccinated a million or two million people with a
vaccine that may not be effective in preventing hospitalisation and severe
disease.
00:12:19
We think that in order to do so we have a more
prudent way in which we can do that which is to make an assessment and then
roll it out on the grander scheme so all that has been suggested at this point
is to delay the roll-out of the AstraZeneca vaccine until we have the processes
in place to undertake this kind of stepwise implementation approach. On that note,
Dr Tedros, thank you very much.
TAG Thank
you. Thank you so much, Professor Abdool Karim. We appreciate everything you're
doing in South Africa and globally in the fight against COVID-19, as you have
done for so many years in the fight against HIV. You have our respect and
appreciation, Professor.
In the next few days WHO expects to make a
decision on the emergency use listing of the Oxford AstraZeneca vaccine for the
two sites in India and the Republic of Korea which will produce it for COVAX.
We're committed to using all available data to make these assessments.
In the meantime COVAX continues to prepare for
its first quarter distribution and to add to its vaccine portfolio. To discuss
the implications of this new development in South Africa for COVAX I'm pleased
to be joined today by Dr Seth Berkley, the Chief Executive Officer of GAVI.
Seth, welcome once again and you have the floor.
00:13:52
SB Thank
you, Dr Tedros, and also thank you, Professor Karim. It's good to have you here
with us. You don't have to be an epidemiologist, as Dr Tedros said, to know
that these viruses evolve and mutate over time. I think the events of the past
weeks, the emergence of these new variants - and this has been a sequential
conversation we've heard about the B117, known as the UK one. We just heard
about the South African one. There's also one in Brazil that is known as P1.
What this serves to highlight is that our
scientific response needs to adapt if we're going to successfully beat this
pandemic. It isn't simple, it isn't going to be one strain globally. So from
the perspective of COVAX, the vaccine pillar of the ACT Accelerator, there are
a number of lessons that are important from these events.
00:14:50
The first is that manufacturers must be prepared
to adjust to COVID-19 viral evolution including potentially providing future
booster shots and/or adapted vaccines if found to be scientifically necessary.
We don't know that now but that is something that obviously needs to be
carefully followed.
It's also clear the trials have to be designed
and maintained to allow efficacy to be assessed over time and to be of
sufficient scale and diversity to enable clear interpretations of their
results. We know that we need much better global genomic surveillance and that
has to be backed by rapid sharing of data to allow for the global co-ordination
of response.
Then lastly - and I know this has been said but
it needs to be emphasised - priority needs to be given to vaccinating high-risk
groups everywhere to ensure maximum global protection against old and new
strains and to minimise as best the vaccine can the risk of transmission
because we know the more that the virus is allowed to spread, the more it is
allowed to be transmitted the more opportunity it has to adapt and mutate.
All of this underlines the need for a global
multilateral solution based upon the principles of equitable access. It also
underlines the need for a diverse portfolio of vaccine candidates suitable for
all contexts, settings and events.
00:16:29
In terms of COVAX we have signed advance
purchase agreements with AstraZeneca and the Serum Institute of India and we've
published plans to distribute nearly 350 million doses in the first half of the
year, hopefully starting later this month should the emergency use listing be
forthcoming that Dr Tedros just talked about and of course this is the first of
many vaccines.
We'll also be looking at the SAGE guidance that
you heard about in terms of their views on the best use of this vaccine in
different groups and in different areas. We're continuing to work through our
partner CEPI - and Richard Hatchett, CEPI's CEO, is on this call - to optimise
and extend the value of these existing vaccines.
We're looking to continue to procure new
candidates for our portfolio for use later in the year including ones that
would be adapted for the new variants if scientifically indicated.
00:17:31
As we have done up until now, we'll continue to
keep you updated on all these developments as and when they occur. So thanks
for giving me the chance to speak and back over to you, Dr Tedros.
TAG Thank
you. Thank you so much, Seth, and we look forward to our continued partnership
to roll out vaccines. I would also like to welcome Dr Richard Hatchett, the CEO
of CEPI, which is a key partner in COVAX. Richard is also available to answer
questions from journalists. Thank you once again to all our guests and
apologies for the delay. Fadela, back to you.
FC Thank
you, Dr Tedros and our guests. I will now open the floor to questions from
members of the media. I remind you that you need to raise your hand using the
raise your hand icon in order to get in the queue to be able to ask your
question. I would like now to start this session by inviting Sophie Mkwena,
SABC South Africa, to ask the first question. Sophie, you have the floor.
SO [Inaudible].
FC Hello?
Sophie?
SO Yes,
my name is Sophie Mkwena from SABC in South Africa. I just want to find out
from the panel; we know that during the Spanish Flu in 1918 the pandemic was
deadly to senior citizens and later to the young generations because of the
very same problem of perhaps the change of the virus itself.
00:19:36
Did the scientists, particularly people with
better know-how, not anticipate that this virus would mutate and we might have
problems so that the developers of the vaccine and manufacturers must take that
into consideration?
Because what guarantee do we have that during
the third wave it will not have another form and previous vaccines won't be
effective?
FC Thank
you, Sophie. Your question is well understood.
MR I
can start; Maria can continue. I think the issue is in 1918 we didn't even know
this was an actual virus causing influenza at that time so therefore there were
three distinct peaks in terms of age groups in the 1918/1919 pandemic. We had
the classic peaks in the very young and classic peaks in the very old but what
we had very unusually was a huge peak amongst young individuals, particularly
amongst young men.
00:20:44
Some of that may have been due to the virus;
some of that may have been due to the mixing of people and the bringing
together of young men in camps. But it was a fulminant disease that killed
very, very quickly and had that very distinct shape.
The first, second and third waves; the second
wave was larger than the first wave and again we don't know that but the virus
may have become more fit to transmission in the human population in a first
wave, may have been better adapted in the second wave and that's what happens.
Flu viruses adapt and they evolve over time and
you see that every year as we change the vaccine strain every year, the strains
that are in the vaccine. We look at the predominant strains, the most
successful strains that are circulating and the ones that are causing clinical
illness. We track the epidemiology of the viruses, we track the type of the
viruses, we track the proteins on the surface of the cells, we track their
genetic sequences and every year we're able to give clear instructions to
manufacturers on how to adapt influenza vaccine.
I think that with the same kind of approach
here, with the same sort of diligence both in epidemiology, in genetic
sequencing and in doing the observational and other studies we're going to need
to do to understand vaccine efficacy I believe we can track this virus.
00:21:58
We have the tools that they did not have in 1918
or 19 and we have the means to adapt and be flexible and react to what we see
so I'm confident that if the scientific, public health and governmental worlds
come together we can have a strategy that will adequately adapt to the
emergence of variants.
MK Yes,
and if I could outline a little bit about that strategy because it is
developing over time and it is getting stronger over time, as this is the first
coronavirus pandemic the world has ever seen we have established surveillance
systems around the world, as you know, looking for where the virus is, by
tracking individuals who are infected with this virus.
But along with that scientists and virologists
have been tracking the virus itself and any changes in the genome of the virus
itself, looking at mutations in the virus evolution which is a natural process
for all viruses and all pathogens.
00:22:52
What we've been doing through our virus
evolution network and our laboratory network and through the improvements of
genomic sequencing around the world; countries have been sequencing viruses in
their countries and they have been sharing those viruses on publicly available
platforms like GISAID and others so that the changes in the virus can be evaluated,
they can be studied and that we can determine what they mean.
Because even if viruses change all the time what
is really critical is to have an assessment framework in place so that we can
determine if any of these changes result in a change in transmissibility,
reflect any changes in disease presentation and severity and importantly if any
of these changes have any impact on available and future diagnostics,
therapeutics and vaccines.
Recognising that this was important for us to be
monitoring we formulated our virus evolution working group in June to have an
assessment framework to determine what studies were necessary in the lab where
we could look at specific mutations or also variants of interest because we
need to determine which ones of those are important to become variations of
concern.
Now what we're looking to is, building on
existing systems like we have for influenza, how do we take the knowledge of
the way that these vaccines behave in terms of their neutralising response and
in terms of the impact of these vaccines - but not only vaccines, also
therapeutics and diagnostics - to say, this is important and therefore there
may be a change necessary for the vaccine.
00:24:31
So that is a process and a mechanism that is
being enhanced, as the Director-General said in his speech today but again
we're not starting from scratch. This is what scientists do. It requires a
robust framework to detect these mutations and variants. It requires strong
collaboration across scientists and labs around the world so that studies are
done to actually properly assess the potential impacts of these viruses and
also to inform vaccine composition.
So there's a lot that's in process here. It will
become stronger as the months go on and it really requires the help and the
persistence of everything from epidemiologic surveillance all the way through
good collaborations with manufacturers.
FC Thank
you. I would like now to invite Mr Richard Hatchett, CEO, CEPI, to add some
elements. You have the floor, sir.
00:25:29
RH Thank
you and, Sophie, thank you for the question. Just to say that, as Maria and
Mike have indicated, we certainly have anticipated that the virus could mutate.
In fact scientists working in laboratories have anticipated some of the
mutations and this is one of the values actually of doing the science. It
allows us essentially to look into the future, to look at possibilities that
may occur and to help us look out for mutations that would be of concern and
interest, as Maria just outlined.
Certainly the emergence of the new strains in
South Africa, Brazil and the UK has given cause for concern. We have taken a
risk management approach not only through COVAX but globally in terms of the
approach to vaccine development and have undertaken the development of vaccines
on a wide variety of platforms; the MRNA vaccines of course; the viral vector
vaccines like the AstraZeneca vaccine that we've been discussing; recombinant
protein vaccines; and inactivated vaccines.
Having that diversity of vaccine candidates actually
provides us with a large number of tools which we need to explore now to see
which work best against the variants that we have. We can also look potentially
at combinations of the vaccines that we have and of course we must accelerate
the development of new strain-specific vaccines and a large number of companies
have already begun to undertake that work.
00:27:10
If the evolution of our understanding of these
viral strains suggests that we do need to progress these vaccines into clinical
trials and then into use we will do that as quickly as we possibly can.
FC Thank
you, sir. I would like now to invite Jon Cohen from Science to ask the next
question. Jon, you have the floor.
JO Thank
you so much for taking my question. I well recognise that this study in South
Africa didn't have enough people or old enough people or people with
comorbidities to answer the severity and hospitalisation and death question but
we have a lot of data from other studies that suggests that vaccines that don't
work particularly well against mild and moderate disease could possibly still
keep people out of hospitals and prevent deaths.
I also recognise that WHO doesn't tell countries
what to do but I'm curious what outside people and experts think about South
Africa's decision to suspend the use in healthcare workers right now in order
to wait to form the trial that Salim described.
00:28:30
So I'm curious if you could address that; what
do you think of that decision to suspend the use right now given the potential
that it could prevent people from being hospitalised and dying?
FC Thank
you, Jon. Dr O'Brien will take this question.
KOB Thanks
for that question. I think underlying the question is really a recognition of
what a dynamic situation it is right now. The evidence has come out very
recently within the past 24, 48 hours. As the Director-General indicated, the
Strategic Advisory Group of Experts on Immunisation at WHO met today along with
the investigators from the trials that are being conducted in the UK and Brazil,
along with AstraZeneca and along with the investigators from the South Africa
trials as well.
So everybody's looking at the data right now and
there are a range of ways that this can be approached but I think what was most
clear that came out from the SAGE meeting is that in looking at the evidence on
the AstraZeneca vaccine across a number of trials it is very clear that it has
efficacy against sever disease, hospitalisations and deaths.
00:29:51
Among the variants and different variants there
are some indications of reduction in the efficacy - some more, some less
depending on which variant, which population - and also of the neutralising
antibody responses.
But we also have evidence that there is the
likelihood that the retention of meaningful impact against severe disease is a
very plausible scenario for the product against the B1351 variant. So as South
Africa deliberates on how they will handle the situation, recognising that
there are a range of products that they're looking at and how to get more data
on exactly what would inform a greater and broader policy; these are
discussions, as we've heard, that continue to be underway about exactly how
they will use the vaccine that they have in hand to its maximum benefit and
assure that there is evidence that can inform not only a broader policy in
South Africa but helps to inform policies around the world.
00:31:13
So we'll see the final wording that comes out
from SAGE on the use of the vaccine but there was a very positive view about
proceeding with the use of the vaccine including in settings where variants are
circulating with a big emphasis on collecting information that would really
help in the weeks to come and in the months to come to inform an optimisation
of those uses in different countries in different settings around the world.
FC Thank
you, Dr O'Brien. I would like now to invite Christophe Vogt from AFP to ask the
next question. Christophe, can you hear me?
CH Yes,
I can hear you. Thank you for taking my question. I was just wondering about
everything we heard now about the AstraZeneca vaccine and I can see how
complicated it is but how much does it affect the roll-out, the number of
vaccines that you can roll out and when for the COVAX facility? It is the bulk
of what you plan to use for vaccination in the next six months so I was just
wondering if you can give us an answer, and also after what Dr O'Brien just
said, that maybe we should just roll out and use it to prevent more severe
cases. Thank you.
FC Thank
you, Christophe. Dr Seth Berkley will take this question.
00:32:51
SB Thank
you for the question. Before I answer that question let me just add one point
to Kate's excellent question and that is we learn more about these vaccines as
we work with them and one important point about the AstraZeneca vaccine is it
was studied originally with a dose interval between two doses of a month.
That vaccine has now gone through trials and
observational studies have shown that in fact a longer dose interval increases
the immune response and also increases the efficacy of the vaccine. So these
types of learnings will occur with new vaccines and that also means that in a
study like the South African study it was not optimised for what we know today
as the way to get the most immune response out of it, etc. This is part of the
debate and discussions that need to go on right now.
But going back to the question, the AstraZeneca
was really the first vaccine. Of course we also have a small number of doses of
the Pfizer vaccine now as well as early vaccines in the portfolio but the idea
was to try to get a very large portfolio of products and we have done that.
00:34:11
So we will be seeing other vaccines enter the
portfolio and be available for participants of COVAX in the second quarter. It
is true that initially it'll be mostly AstraZeneca and Pfizer that are moving
forward but then there'll be more vaccines and of course, as Dr Hatchett said,
one of the things we'll be looking at is whether any or all of these vaccines
need to be adapted and adjusted either in the way they're being used or even in
the actual make-up of the vaccines.
So this is an evolving science, as you heard
from Kate, and we will continue to work as COVAX to ask the question, what is
the best way to move forward. But at the moment at least - and we'll wait for
the SAGE guidance - it looks like the AstraZeneca vaccine is an efficacious
vaccine. It's been reviewed by a number of stringent regulatory authorities and
got approval and had studies in many countries including efficacy against
severe disease, as you've heard, including efficacy against some of the
changing variants and therefore we suspect that we will continue to roll that
out and will continue to follow the effects of that vaccine over time.
00:35:37
FC Thank
you, Dr Berkley. I would like to invite Professor Salim Abdool Karim to also
provide some elements to this question. Professor, you have the floor.
SAK Thank
you very much. Just to add a quick comment that even in the South African
setting we were scheduled to roll out the AstraZeneca vaccine in just over a
week from now. We anticipate that the initial start date of vaccinations will
be largely unaffected or at most be affected by a few days but instead of
rolling out AstraZeneca vaccine we will be rolling out the Johnson & Johnson
vaccine.
That'll give us a bit of time and leeway to
ensure that we're collecting the necessary data as we roll out the AstraZeneca
in a stepwise process so it doesn't really materially affect our start date. It
may affect the rate at which we escalate if we start running short of doses but
as it stands it should not affect much else. Thank you.
FC Thank
you, Professor. I would like now to invite a Brazilian journalist, Sara Teofilo
from Coriero Brasilense to ask the next question. Sara, you have the floor.
00:36:54
SA Hi.
Thank you for taking my question. Still on the subject of the variant in South
Africa and the suspension of the use of the Oxford vaccine, in Brazil we also
have a variant identified in Amazonas, as was said here today and we know it is
a different variant but does the Organization have any orientation to Brazil?
Should the Government suspend the use of the AstraZeneca vaccines and use the
other vaccines until we know this variant does not interfere with the
effectiveness of the vaccine?
FC Thank
you. Dr Swaminathan, you have the floor.
SS Thank
you for that question and again just to repeat what others have said, we are
learning a lot, there are uncertainties still, we don't have answers to all
questions. The SAGE, the Strategic Advisory Group of Experts on Immunisation,
is reviewing all the evidence that's available on each of the vaccines from all
the different studies starting from very early clinical all the way to the
phase three trials and also taking into account what we know about the
different variants and experiments that are being done both in the laboratory
looking at neutralisation assays and if there's any clinical evidence, taking
that into account.
00:38:16
We'll make recommendations based on the
available evidence and of course these can be updated and revised as more data
becomes available. All of our guidelines are meant to be updated, they're
living guidelines and we will do that but again based on the best available
evidence.
Countries of course will make their own
decisions based on initial information that they may have and we can help them
and work with them to make those decisions. One thing I would like to say is
that there is an urgent need to collect more information and data so even as
countries are rolling out vaccines, whatever the vaccines may be it's really
important that we put in place mechanisms to either do clinical trials where we
can randomise for example the question about the optimal timing between the two
doses; the question of efficacy in different age groups; the question of is it
better to use one vaccine followed by a different vaccine as a booster dose.
All of these questions need to be answered and
we would like to promote that kind of good research whether it's trials or
whether it's observational studies, cohorts that are monitored for both
effectiveness and safety and then have a global database where we keep learning
so that we use these vaccines more effectively.
00:39:47
Even as, as Richard Hatchett from CEPI was
saying, we are investing in the development of more vaccines, those trials need
to be done as well. So I think the next few months are going to be important
for us as we roll out, to keep on learning and adapting our strategies. I don't
know if you want to add anything, Kate.
KOB Yes,
if I can just add a couple of things, we did speak at SAGE about the P1 variant
and the AstraZeneca vaccine and had an update on the expectation about when we
would have more information that would be evidence to inform decisions like this.
I think it's so important that we recognise that
information is going to continue coming out and we really have to sail a steady
ship based on the preponderance of evidence and not lurch from one particular
report or another report because in science there is variability in the biology
of how vaccines work in different populations at different points in time,
among different groups in populations.
So what's really critical is as evidence emerges
to look across all of the elements, the structural biology of the virus itself
and the variants, the nature of the vaccines that we're actually looking at,
the ages of the people that were in clinical trials, the kind of disease that
was actually monitored in the clinical trials.
00:41:29
Each of these elements has an impact on what the
expectation would be about the performance of the vaccine and therefore
comparing from one piece of evidence to the next really can't be done without a
sort of level playing field.
So I think people really have to be ready to
appreciate that we will have evidence that's going to come out that is going to
at times have the appearance that it doesn't add up to one complete story and
that's because we're painting the picture in parts and pieces and bits as time
is going on.
But when we put all that evidence together we
have a clear way forward of the way in which we can most effectively use the
vaccines while we're learning all the time about optimising those products.
FC Thank
you, Dr O'Brien. I believe Mr Richard Hatchett has something to add. You have
the floor, sir.
00:42:31
RH Thank
you. I just wanted to follow up on Dr Swaminathan's comments. She mentioned a
number of studies that need to be undertaken. I just wanted to flag that COVAX
through CEPI has issued a call for proposals. We've set aside $140 million to
support the conduct of such studies and that call was opened about ten days ago
so we will support these necessary studies to understand how to best use these
vaccines.
FC Thank
you, sir. I would like now to call on Nadia Doui, a Tunisian journalist from
L'Economist Maghreba. Nadia, can you hear me?
TR Good
evening, everyone. I'm a Tunisian journalist and I work at the magazine
L'Economist Maghreba. I'd like to ask your question in French if that's all
right.
This is my question; it's about the new
variants, especially the South African and Brazilian variants. There are many
questions about these variants and some people are being singled out as
carrying this variant and even if they have a PCR test that has been negative
some people suspect that they could still be carrying those variants.
00:44:05
FC Nadia.
MK I
can start and others may want to come in on this. I'm not sure if I understand
the question completely but it's about the variants and about the viruses that
people are infected with. I think first and foremost we need to not stigmatise
anyone that is infected with the SARS-CoV2 virus, full stop, regardless of if
it's the wild-type viruses that are circulating from the beginning or these new
variants that are circulating.
All of us are doing everything that we can to
keep ourselves safe and keep our loved ones safe and if we happen to be
infected with this virus we need proper protection, we need proper care and
understanding from our loved ones and our employers so that we can get better
and we can take the necessary public health measures to prevent us from
spreading that virus to someone else.
There is a lot that is not well understood about
all of these different virus variants that are being detected but as you have
heard us say, there are many studies that are underway and we are learning
about these variants and this virus every day in real time.
00:45:09
There are collaborations that are set up, there
are relationships that WHO and our partners have with researchers in country
who are carrying out studies as we speak, as we sit here, explaining this to
you because everyone is working towards better understanding of how the viruses
transmit, the disease that they cause, the severity that one may have if
they're infected with these virus variants and of course any potential impacts
of our countermeasures like diagnostics, therapeutics and vaccines.
So while we don't have all of the answers - we
never will - we have systems in place to make sure that there's surveillance,
that there's data sharing, that there's co-ordination around research that
needs to be done, that there is a mechanism by which those results can be
shared, there are expert panels that are discussing these regularly to
interpret what these mean as we know it at the time that we discuss it and,
really importantly, that we outline the studies that are necessary going
forward.
But I do want to highlight again that we
shouldn't stigmatise anyone who is infected with SARS-CoV2, the virus that
causes COVID-19. We just need to make sure that we understand we're in this
together and we provide the appropriate care and understanding for those who
are infected and their loved ones who are contacts and need to get through
this.
00:46:32
FC Thank
you. I would like now to invite Pen Gui from People's Daily, a Chinese
journalist, to ask the next question. Pen Gui, are you with us? Hello, can you
hear me?
PG Can
you hear me?
FC Yes.
Hello. Hello?
PG Hi.
Can you hear me?
FC Yes,
we can hear you. Go ahead, please.
PG Thank
you for taking my question. China declared last week that it had decided to
provide ten million doses of vaccine to COVAX. Can you share more information
about that, about the collaboration with China? Thank you.
00:47:26
FC Dr
Swaminathan, you have the floor.
SS Yes,
thank you for that question. As you know, we want to work with developers and
manufacturers of vaccines all over the world. We need as many good, safe and
efficacious vaccines as possible. China has several vaccines under development
and we're speaking with all of them and we are also looking at the dossiers for
Sinopharm and Sinovac.
The team is in China, as Dr Simao mentioned and
we've also heard from them that they would be willing to discuss with the COVAX
facility provision initially of ten million doses over the next few months so
we're very encouraged by that. This is not a donation as we understand but it
will be a provision to the COVAAX so they will be discussing with the COVAX
facility the terms and conditions under which this can be procured based of
course upon the emergency use listing by WHO as well as the guidance from SAGE.
Thank you.
FC Thank
you, Dr Swaminathan. I would like now to invite Simon Ateba from Africa News
Today to ask the next question. Simon, you have the floor.
00:48:46
SI Thank
you for taking my question. This is Simon Ateba for Today News Africa in
Washington DC. Hospitals in Malawi are now on the brink of collapse,
overwhelmed my patients impacted by a COVID-19 variant first identified in
South Africa.
When the country needs only 40,000 vaccine doses
to vaccinate healthcare workers to continue to treat others and this is the
situation in other countries in Africa where healthcare workers need to be
vaccinated first to take care of other people, what are the WHO, COVAX and
others doing to ensure that healthcare workers are vaccinated right away, not
in two weeks or in three weeks?
If I may ask, apart from rejoining the WHO is
President Biden doing anything to help Africa's vaccination effort? Thank you.
FC Two
questions, Simon. Okay. Dr Bruce Aylward will take your first question.
BA Thank
you very much. Simon, everybody is deeply concerned about the roll-out of
vaccines globally and everyone - it's not just WHO; everyone we work with is
doing everything possible to scale up and ensure countries that have not yet
been reached with products can be reached.
00:50:06
So WHO is doing this in the context of the COVAX
pillar of the ACT Accelerator that we work within and Seth may want to make
comments on this as well but there's really a four-part approach we're taking
to this right now and we're doing all of this right in parallel.
The first is to try and ensure that those
products that we've contracted large volumes for and that we know are
efficacious and safe get through the regulatory process as rapidly as possible
and that is the AstraZeneca vaccine, as Kate and others have spoken to already.
The second thing we've been doing is working to
expand the portfolio of vaccines, as Dr Berkley mentioned so we're looking at
other products that have already been licensed. The Pfizer vaccine; we struck a
deal with Pfizer two weeks ago and we're looking at expanding on that.
The third piece of work that we've done within
the COVAX facility is to establish the capacity to take donations and doses
that are shared from countries that feel that they are in a position to be
sharing doses so we've established the capacity to do that, which can be done
immediately.
00:51:12
Then the last thing that we're doing is we're working
to assess other potential suppliers. I think Mariangela or someone referred
already to the fact that we have team on the ground in China that's assessing
the facilities at Sinovac and Sinopharm.
At the same time we're looking at their
dossiers, their data to see if those products would be suitable for
consideration in the facility so we've got a broad, four-pronged at least
programme of work.
The other thing that we're doing is as we do
those things in parallel if things look very promising we're going out with
countries with indicative volumes of vaccines. As you saw, Dr Berklee's team
from GAVI issued what we call the indicative volumes to be able to tell
countries, here's how much vaccine you can expect in the coming months so that
they can prepare and prepare their timelines appropriately.
Then linked to that we're also already informing
not just the countries but informing the manufacturers of these products, look,
this is a list of countries that you may need to be shipping vaccines to within
the next week as some of these products will have a final position on their
regulatory processes.
00:52:28
So, Simon, please rest assured that everybody
working in COVAX, the partners working with them are doing everything possible
to make sure that products arrive everywhere as rapidly as possible. But
remember we made a commitment when we established COVAX that we would make sure
the vaccines that we deliver are safe, efficacious and quality-assured.
We made that promise to the world, to the people
of the world and it takes time to examine everything possible on these vaccines
and make sure that they meet what are quite stringent regulatory requirements
so that when they go out people have the absolute confidence that these
products are going to work and that they're going to be safe.
FC Thank
you, Dr Ryan.
MR Just
on the specific issue of Malawi and certainly South Africa has seen a very
rapid rise in cases and that rise is - that's falling now and a number of
countries in the southern African area including Malawi have seen a similar
very rapid rise in the number of cases. I believe they peaked in Malawi with
1,316 confirmed cases on 22nd January.
00:53:38
That number has now fallen to 320 on 7th
February and that's been a persistent fall in the number of cases. Gain that's
testament to all the other work the Government of Malawi are doing in terms of
testing and isolating and quarantine and treating cases. That's happened in the
absence of vaccines.
We've seen similar falls across Europe even in
areas where there's been a high proportion of variant strains associated with
transmission. Overall when we look at variant strains in some areas the data
would suggest that they can be up to 30 or 50% more transmissible but they're
not able to get around our defences.
When those public health and social measures are
applied, when people wear their masks, when people stay away from crowds, when
people wash their hands, when people avoid crowded places and when governments
take the necessary action those numbers fall.
00:54:33
We need to continue to have those numbers fall
and clearly understanding the impact of the variants on transmission and on
vaccine efficacy and others is very important but I think the message is the
measures we currently have in our toolkit work and we need to apply them. They
are our first line of defence, they are what are going to stop this disease
getting out of control.
This will keep the number of variants down and
allow the vaccines to come in and do their job and the primary job of vaccines
right now is to reduce hospitalisations and death. Right now the data on, I
think, all of the vaccines in all of the situations is they're working to do
that.
We may need second and third-generation vaccines
to do more, we may need better vaccines to do more than just stop deaths and
stop hospitalisations but right now we have the tools to stop both by adequate
control of disease at community level and by the use of vaccines to protect the
most vulnerable and our front-line health workers.
In emergency management you've got to do what
you can do now, you've got to face the realities you face now and the realities
we face now are we can suppress transmission and we can save lives.
00:55:43
If we do that we can take the next steps and
rest assured, the team here, Kate and Soumya and Annamaria and the R&D
blueprint and Richard and everyone outside; they're working hard to find those
solutions on the vaccine side and working hard with our colleagues on the flu
programme to develop a system to monitor this and do this in a sustainable way.
But I do think we need to focus on what we have
at our disposal. No-one would like more than us - and going back to previous
questions, we still want to see health workers and vulnerable people all over
the world vaccinated, that is still a primary objective of this organisation.
I think the partners in the ACT Accelerator, the
partners in COVAX led by the DG are making every effort to ensure that we can
maximise the fair and equitable distribution of this vaccine that is saving
lives and can save more lives.
00:56:39
FC Thank
you. I think we will take the last question from Gabrielle Steenhauser, Wall
Street Journal. Gabrielle, can you hear me?
GA Yes,
I can. Thank you so much. Can you hear me?
FC Very
well. Go ahead, please, Gabrielle.
GA Given
that it's going to take some time to get more evidence on how the AstraZeneca
vaccine works with the South African variant shouldn't COVAX maybe prioritise
other vaccines such as the Pfizer vaccine for countries in southern Africa
where this same variant is prominent at the moment? Can't you shift some of
these vaccines to those countries so that the front-line healthcare workers get
the best protection that is available right now?
FC Thank
you. Dr Swaminathan, you have the floor.
SS Maybe
I can start and then Dr O'Brien can come in. There are several issues here. The
first one is [sound slip] we mustn't start concluding that this vaccine doesn't
work at all. What we've seen is data from a small study. It's indicative, it is
telling us we need to collect more data, we need to study more.
But from all the available evidence AZ vaccine
and all the other vaccines that have been approved so far reduce death, reduce
hospitalisation and reduce severe disease and that's our goal for the first
part of this pandemic, to reduce mortality, to end all preventable deaths and
so we must continue to scale up vaccines.
00:58:21
About which vaccine, it depends on what's
available in the COVAX facility at the particular time and also what's feasible
and, as you know, the Pfizer vaccine has some special requirements; ultra-cold
chain storage and transport, which is not available in all countries in Africa
or in other parts of the world.
So we've done an extensive mapping and Kate can
speak to how this has been looked at at the country level. So that's an
important issue but also it's the supplies. The COVAX facility had made prior
arrangements to get a lot of supplies of the AZ vaccine in millions of doses
whereas the Pfizer; we have a very limited supply, especially in the first part
of the year.
So there are all of these considerations and the
important thing is to get these vaccines out to healthcare workers and other
high-risk groups as soon as possible. Do you want to add some points, Kate?
00:59:21
KOB Yes,
I think the other thing to mention is that for pretty much all of the products
we do know that the efficacy against severe disease is a higher efficacy than
against mild disease or just infection. We're starting to get some evidence
around infection without people actually having disease.
So we do expect this gradient and I think
especially for the AstraZeneca product the absence of evidence is the key thing
about what is the performance of the vaccine against severe disease of this
particular variant.
The expectation is that it will have - there's a
very plausible scenario where it will have efficacy of some magnitude against
that severe disease. So I think what we want to also emphasise here is the
reason to have a portfolio of vaccines in the COVAX facility and that are being
pursued from a development perspective is that different vaccines are going to
have different performance characteristics and when we get to a point of supply
where we have that flexibility to be optimising products where we now have
information about how they can best be used...
01:00:36
And I think this I what we're talking about,
about the optimisation but the optimisation isn't just about the product
itself; it's about how you use it and so we've referenced before the information
that is now more and more clear that the longer the interval between the two
doses of this product the higher the efficacy is.
So again I think what we're trying to emphasise
is that we have a number of choices that any individual programme can make about
how to make best use of what's available at a particular moment in time;
extending intervals, using products in some age groups with preference over
other age groups where we're really targeting an age group or a particular
group largely for the protection against severe disease or another group that
doesn't have such high risk of that but we're more concerned about mild or
moderate disease.
So the choices that an individual country makes
about how best to use the products that are at hand is going to be a rather
organic process at this period of time where we're still learning so much about
each of the products and the supply is increasing over time and availability
for any one particular geography has variability compared with another
geography.
01:01:59
FC Thank
you, Dr O'Brien. I believe Mr Richard Hatchett has something to add. You have
the floor, sir.
RH I
just wanted to build on the comments that Dr Swaminathan and Dr O'Brien made
with respect to the utility of the vaccines that we have. Obviously there is a
world full of the wild-type virus that the AstraZeneca virus is known to work
against so it is vastly too early to be dismissing this vaccine as... This is a
very important part of the global response to the current pandemic and we need
to find better vaccines probably against the variants that are emerging but we
still have a lot of information that we need to gather.
Mike made a very important point that I think is
worth underscoring; it's absolutely crucial to use the tools that we have as
effectively as we possibly can and that may mean ultimately when vaccine
supplies increase thinking about deploying certain vaccines to certain
geographies.
We don't have that luxury yet but we do have a
suite of vaccine tools that we can probe and understand how to use them most
effectively. In the current state we are working rapidly, many of the companies
are working rapidly, as I said, to develop new vaccines that are specific for
the emerging strains and we are also looking at second-generation vaccines that
have different attributes and that may provide broader protection.
01:03:42
Ultimately ideally we would like to develop
broadly protective COVID and even coronavirus vaccines so there is a staged
approach to the necessary research and development that is absolutely critical,
to continue to support that research and development so that we understand the
tools that we have, we optimise them and we develop the new tools that we will
need for the future. Thank you.
FC Thank
you, sir. I would like now to invite Dr Tedros for his final comments. Over to
you, Dr Tedros.
TAG Thank
you, Fadela. I would like to start by thanking our guests today, Professor
Abdool Karim, Dr Berkley and Dr Hatchett. Thank you so much for joining and for
your partnership and also thank you to all who have joined today, to the media
community and look forward to seeing you again in our upcoming or next presser.
Thank you; all the best.
FC Thank
you, Dr Tedros. I remind journalists that we will be sending the audio file and
Dr Tedros' remarks right after the press conference. The full transcript of
this press conference will be posted tomorrow on the WHO website. The press
briefing is now closed. Thank you.
01:05:04