COVID-19 Virtual Press conference transcript - 5 January 2021
Overview
COVID-19
Virtual Press conference
5 January 2021
Speaker key:
FC Fadela ChaibTAG Dr Tedros Adhanom Ghebreyesus
AC Dr Alejandro Cravioto
CH Christine
KOB Dr Kate O'Brien
SO Sophie
MK Dr Maria Van Kerkhove
AS Ashley SS Dr Soumya Swaminathan
IM Imogen
JH Dr Joachim Hombach
PA Pamela
DO Donato
EM Emma
MS Dr Mariangela Simao
MR Dr Michael Ryan
BA Dr Bruce Aylward
AG Agnes
00:00:00
FC Hello, all. This is Fadela Chaib speaking to you from WHO headquarters in Geneva and welcoming you to our global COVID-19 press conference today, Tuesday 5th January, our first press briefing of 2021. I'm sorry for the delay and thank you for your patience. The focus today will be on COVID-19 but we will also brief you on the outcome of today's virtual meeting of SAGE, the strategic advisory group of experts on immunisation. We will be joined by a special guest, the SAGE chair, whom Dr Tedros will introduce.
Present in the room are WHO Director-General, Dr Tedros, Dr Mike Ryan, Executive Director, Health Emergencies, Dr Maria Van Kerkhove, Technical Lead on COVID-19, Dr Bruce Aylward, Special Advisor to DG and Lead on the ACT Accelerator, Dr Mariangela Simao, Assistant Director-General, Access to Medicines and Health Products, Steve Solomon, Principal Legal Officer, Dr Joachim Hombach, SAGE Secretariat.
Joining us remotely are Dr Soumya Swaminathan, Chief Scientist, Dr Kate O'Brien, Director, Immunisation, Vaccines and Biologicals. Welcome all. Simultaneous interpretation is provided in the six UN languages plus Portuguese and Hindi. Now without further ado I will hand over to Dr Tedros for his opening remarks. Dr Tedros, the floor is yours.
00:01:53
TAG Thank you. Thank you, Fadela. Good morning, good afternoon and good evening. Wherever you are I wish you a Happy New Hear. In our first briefing of 2021 I want to take a quick step back and tell you what's going to be coming up in the next few weeks. The pandemic is still a major public health crisis. We're in a race to save lives, livelihoods and end this pandemic and I will share more on that shortly.
However WHO is not just fighting the pandemic. We're fighting numerous disease outbreaks across the world, picking up and analysing hundreds of potential signals every week and our work goes far beyond emergencies. We work to improve human health in all its aspects from birth to old age.
As shown in the past year WHO is working day and night to accelerate science, provide solutions to challenges on the ground and build global solidarity. This is as important for tackling the pandemic as it is for getting essential services back up and running again; from preventing mothers and their children dying in childbirth to tackling silent emergencies like antimicrobial resistance and mental health to the prevention, screening and control of HIV, TB, malaria and neglected tropical diseases.
00:03:36
This month for example is cervical cancer awareness month where WHO is working with partners around the world to accelerate the first global health strategy for the elimination of a cancer.
We have learned a lot in the last year, not least that health is an investment in overall development, critical for thriving economies and a key pillar of national security. Health cannot be an afterthought when we have an emergency. We must ensure truly integrated primary healthcare systems that effectively prevent, screen and treat infectious diseases and non-communicable diseases like diabetes, cancer and heart and lung disease.
The latter collectively lead to the deaths of more than 40 million people every year. The COVID-19 pandemic has shown us once again how a new infectious virus puts those with underlying conditions at highest risk of dying. Those countries that have high numbers of people with health conditions put extra stress on the health system and we must work with those focused on the climate crisis which directly impacts health.
00:04:59
Ultimately we need to invest in preparedness and surveillance to stop the next pandemic and ensure that everyone has access to quality health services. In the year ahead scientists and public health experts from inside an outside WHO will continue to work with us to break down the latest science and innovations and put forward solutions so that we can build back greener and stronger health systems.
My one hope is that there is less politicking about health in the year ahead. We have entered a new phase to the pandemic where solidarity is needed like never before. We are in a race to save lives right now and as my colleague, Dr Mike Ryan, said back in March last year, it's important in any crisis to act fast and have no regrets.
Caseloads are so high in several countries that hospitals and intensive care units are filling up to dangerous levels. For some countries during the recent holiday period and cold weather people mixed indoors more, which we know is riskier and will have consequences.
00:06:22
New variants which appear to be more transmissible are exacerbating the situation. We call on all countries to increase testing and sequencing of the virus so that we can monitor and respond effectively to any changes.
Ultimately countries have to consider their epidemiological situation and take appropriate measures based on the data. It's a tough balancing act but ultimately saving lives, protecting health workers and health systems must come first.
I know it's tiring but it's many times worse for those working or being treated in an overcrowded hospital or for people who have had their cancer treatment postponed. So we must act for the most vulnerable that need help right now.
As well as minimising contacts in this critical period governments must support people who have to isolate or quarantine. Just as governments have generated stimulus to keep economies going it's important to find innovative ways to offer people the chance to isolate safely away from others.
To break chains of transmission we must identify and find those who are infected, provide the care they need and help them truly isolate safely.
00:07:58
We are in a race to prevent infections, bring cases down, protect health systems and save lives while rolling out highly effective and safe vaccines to high-risk populations. This is not easy. These are the hard miles we must tread together but if we act together we can win both races and get ahead of the virus while also limiting the opportunity for the virus to mutate further and threaten the health tools we currently have.
Last week WHO issued its first emergency use listing for a COVID- 19 vaccine, the Pfizer BioNTech vaccine and yesterday it was also encouraging to see the AstraZeneca vaccine roll-out begin in the first country. One year on from WHO issuing its first disease outbreak news report about this virus more than 30 countries have started vaccinating their high-risk population areas with various COVID-19 vaccines.
The scientific community has set a new standard for vaccine development. Now the international community must set a new standard for access. COVAX has been backed by 190 countries and economies and I want to see all manufacturers channel supply to COVAX quickly so that roll-outs can begin and those at high risk are protected around the world.
00:09:45
We owe it morally to health workers everywhere who have been fighting this pandemic around the globe for the best part of a year to vaccinate them all as soon as possible. People must come first over short-term profits. It's in countries self-interest to shun vaccine nationalism. Vaccinating health workers and those at high risk of serious disease is the fastest way to stabilise health systems, ensure all essential health services are up and running and that a truly global economic recovery can take place.
I urge all governments to work together and live up to their commitments to equitable distribution globally and all pharmaceutical groups to boost supply as quickly as possible and to fully participate in COVAX. The 100/100 initiative driven by WHO, UNICEF and the World Bank is supporting over 100 countries to conduct rapid readiness assessments and develop country-specific plans for vaccines and other COVID-19 tools.
So far more than 90 countries have already completed the assessments and our teams are working around the clock to ensure that governments and health systems are ready for global vaccine roll-out but we need consistent, predictable, affordable supply of safe and effective vaccines.
00:11:17
Morally, economically, socially and for global security we must act together right now to ensure equitable roll-out. Following the emergency use listing last week the SAGE group met today to discuss policy recommendations for the use of the Pfizer vaccine. I would like to invite the chair of SAGE, Dr Alejandro Cravioto, to tell us about the recommendations. The floor is yours, Alejandro.
AC Thank you very much, Mr Director-General, and a Happy New Year to you to. The strategic advisory group of experts on immunisation was established by the Director-General in 1999 and it's comprised of 15 experts from around the world charged with providing independent advice to the WHO DG on all policyrelated issues of vaccines and immunisation. The group is very well-balanced geographically and gender-wise.
00:12:31
In June of last year, as we do with other vaccines, SAGE set up a working group for the COVID-19 vaccines that were being developed. The group consists of 26 experts from around the world in all different areas and has consistently been working for the last months at least two or three times a week to be able to help us develop a number of documents and issues that we have been reviewing at SAGE level.
The first product of the working group was a values framework for allocation and prioritisation which was presented to the DG and approved in September of 2020 and then a roadmap of prioritisation for the group that should be set up for vaccination which was also approved and disseminated in October of 2020. These documents have been translated into all the UN official languages or the WHO official languages.
Today we met to look into the approval of the WHO emergency use listing of the Pfizer/BioNTech MRNA COVID-19 vaccine. The meeting was initiated with a review of the current situation of the COVID vaccine development pipeline and of course the issues related to these SARS CoV2 virus variants, which is something that is worrying everyone.
We looked at the global, regional and country-level plans for COVID vaccine safety monitoring and we looked at the safety and efficacy data from phase one to three clinical trials of the Pfizer/BioNTech MRNA COVID-19 vaccines, BNT162B2.
00:14:38
This was presented by the Pfizer and the BioNTech experts and was discussed by the SAGE members and the members also participating in the session. We deliberated and came out with the following recommendations.
SAGE recommend the administration of two doses of this vaccine within 21 to 28 days. While we acknowledge the absence of data on safety and efficacy after one dose beyond the three/four week studies in the clinical trials SAGE made a provision for countries in exceptional circumstances of vaccine supply constraints and epidemiologic settings to delay the administration of the second dose for a few weeks in order to maximise the number of individuals benefiting from a first dose.
In the case of the anaphylactic reactions after administration of the Pfizer vaccine that have been reported outside of the clinical trials SAGE recommended that the vaccine should be administered only in settings where anaphylaxis can be treated.
00:15:58
We provided a specific narrow exclusion for vaccination and on the observation period as well as the management, monitoring and reporting of any safety events. We recognise the importance of vaccination of pregnant women especially given the priority for protection of health workers, of whom a large proportion globally are of course women.
Nevertheless in light of the data limitations SAGE was not able to provide a recommendation for the use of the vaccine in pregnancy until more safety data are available. However we made a provision for situations where the benefit of vaccination of a pregnant woman outweighs the potential risks, such as health workers at high risk of exposure. We have done this before for other vaccines, as the use of the Ebola vaccine in the Democratic Republic of Congo before.
SAGE acknowledged the lack of data for recommending the vaccine to lactating women and given the importance of breastfeeding we encourage the company to be able to bring information necessary for us to make a decision in the near future.
00:17:23
As with the case of the pregnant women we have also made a provision in which if a woman is part of a high-risk group then we'd recommend the vaccination without the stopping of the breastfeeding.
SAGE recommends that COVID vaccination be offered regardless of a person's history of asymptomatic or symptomatic SARS-Co2 infection. Available data currently indicate that symptomatic reinfection within six months after an initial infection is rare. Thus in the context of limited vaccine supply persons with a PCRdocumented SARS-CoV2 infection in the preceding six months may choose to delay vaccination until near the end of this time period.
This would encourage the use of the vaccines for other people who have not been exposed to the virus and thus have a much larger portion of the population protected. As noted in the prioritisation roadmap SAGE re-emphasised that national programmes should take specific steps to identify groups that are proportionally affected by COVID-19 and those who face health inequities due to social structural inequities in order to address barriers to vaccination and achieve equitable access to the products.
00:19:08
In the current period of very limited supply preferential vaccination of international travellers would count as a principle of equity. Because of this and the lack of evidence to inform whether vaccination reduces the risk of transmission SAGE currently does not recommend COVID-19 vaccination for travellers unless they are also part of a high-risk group identified within the prioritisation roadmap.
SAGE recommends the continued post-authorisation monitoring of COVID-19 vaccines for effectiveness and safety and listed multiple specific areas of additional research on COVID-19 vaccines such as vaccine efficacy against SARS-CoV transmission, duration of protection, vaccine efficacy against the virus variants, vaccine efficacy and safety in children younger than 16 years old, immunogeneicity and safety and especially cotransmission with other vaccines and vaccine interchangeability. This is important especially with the co-administration for the elderly group with an influenza vaccine if that were possible.
In the coming weeks and months we will continue to review the other vaccines as they become available and with the data coming from the manufacturers when made available for these deliberations and as part of the regulatory processes are undertaken.
00:20:46
The recommendations have been sent to the DG for approval and once this has been achieved then we will publish them in the weekly epidemiological record in a few weeks so that everybody is aware of this first approval of this COVID-19 vaccine. I would leave it there, sir, and see if there are any questions that somebody would like to ask. Thank you very much.
FC Muchas gracias, Alejandro.
AC De nada, Senor.
FC Every country needs to row in unison in the same direction to beat this pandemic. Solidarity, multilateralism and collaboration are key so that we win the race against this pandemic quickly and escape these stormy waters together.
00:21:48
Lastly over the past 24 hours members of the international scientific team on COVID-19 virus origins began travelling from their home countries to China. This was as per arrangements jointly developed between WHO, the Chinese Government and the countries from which the team was manned to travel through on their own on their way to Wuhan.
Today we learned that Chinese officials have not yet finalised the necessary permissions for the team's arrival in China. I'm very disappointed with this news given that two members had already begun their journeys and others were not able to travel at the last minute.
But I have been in contact with senior Chinese officials and I have once again made it clear that the mission is a priority for WHO and the international team. I have been assured that China is speeding up the internal procedure for the earliest possible deployment. We're eager to get the mission underway as soon as possible. I thank you and once again Happy New Year. Fadela, back to you.
FC Thank you, Dr Tedros, and thank you, Dr Cravioto. I will now open the floor to questions from journalists. I remind you that you need to use the raise your hand icon in order to get in the queue. I would like now to invite our first journalist, Christine Theodoro from ABC News, to ask the first question. Christine, are you with us?
00:23:35
CH Yes, I'm here. Can you hear me?
FC Yes. Please go ahead.
CH The idea of doing booster shots in order to administer an initial dose of vaccine to a larger population; given the situation in the United Kingdom one can understand the logic in trying to provide some degree of protection to more people. But given that there're so many outstanding questions on these vaccines, for instance how long protection lasts, is there enough data to support this approach? Does a single dose compromise protection?
And on the ethical considerations in using the general population to answer these outstanding questions I wanted to get your take. Thank you.
00:24:13
FC Thank you, Christine. I would like to invite Dr O'Brien to take this question. Dr O'Brien, you have the floor.
KOB Thank you. This is clearly an area... I think everybody realises that we're operating in a space where the amount of evidence to drive policy decisions is evidence that is evolving. I think what is really important here is to recognise that policymakers are using all of the evidence that is in front of them and what SAGE was deliberating on today was, I think, what many communities are doing which is they are weighing the evidence that we do have about the efficacy and the immunogeneicity that has derived from clinical trials where the timing of doses is delivered in a specified timing against what to do around the possibility and some evidence that shows the possibility that single-dose efficacy between the timing of the first and the second dose is quite high.
Therefore in a setting where there is constrained supply the procedure, the operational procedure about how to use these vaccines really is weighing one risk against a second risk. One risk is that we are very, very scrupulous about applying the vaccines and the way that they were applied in the clinical trials that generated the evidence on efficacy and in doing so we may have some limitation of the number of people who can receive the first dose depending on how the supply is rolling in.
00:26:16
Then the second risk is that if we allow for a broader use of vaccine as first doses there may be some delay in getting the second dose among some people. So it's really a trade-off of two risks and I think what we're seeing around the world is different committees are weighing those risks and discussing those risks in different ways.
Perhaps Alejandro can chime in with a couple of comments as well but I think there was a very robust discussion within SAGE around the trade-off of these risks and the recommendation that came out of SAGE was to allow for this somewhat extended interval that went up to a six-week period in settings where... the concern around the epidemiology and the supply, the prediction of supply.
But that was allowing for a period of time that was an outer limit in the clinical trials. I'll turn it over to Alejandro and see if he wants to say any more about how the committee was trading off those two risks.
AC I think Kate has explained it as well as it should be. I don't think we have anything else to add. In a sense I think we have to be a bit open to these type of decisions that countries need to make according to their own epidemiological situation.
00:27:53
What we need in SAGE is to base our recommendation on hard evidence available to us at the time that we make our decisions and in this sense in general for the use of this vaccine we do recommend that we use two doses with a space interval of 21 to 28 days.
However a country might need to use the vaccine in a different way for many different reasons and that is something that competes then to a local decision which goes beyond the recommendations that we're able to make at this time.
KOB May I just add one more point. I really do want to emphasise that SAGE was deliberating about evidence on the Pfizer vaccine only today. This is a very important point. We will deliberate, SAGE will deliberate on other vaccines in other sessions in the coming short number of days and weeks but what is the output from SAGE today was only about the Pfizer vaccine.
FC Thank you. I would like now to invite the next journalist. I would like to invite Sophie Mkwena from SABC to ask the next question. Sophie, are you with us?
00:29:18
SO Thank you. I just want to check; in terms of the report around the variant that was detected in South Africa, we had the Minister or the Secretary of Health in the United Kingdom saying that this variant is more dangerous and there's a possibility that the vaccine will not be able to deal with the problem or the vaccine will not be effective. Have you investigated that?
And the last question to Dr Maria Van Kerkhove; you saw the video where you're talking about growing the variant of the virus in the lab going viral in South Africa. Perhaps you'd want to clarify that.
MK Hi, Sophie. Happy New Year. Thanks for both of those questions. I'll start with the second part first. I did address your question also on Twitter because there was some confusion about my statement on growing of the virus.
This is part of the process of trying to grow the virus in a lab, in cells, not in humans, to have enough quantity of the virus - it's done under very controlled settings - so that you have enough virus to do these experimental studies to look at the potential impacts of what this virus does and means.
00:30:44
So it's not growing the virus in humans; it's growing the virus in cells under controlled conditions. Thanks for letting me clarify that.
With regard to your first question on the variant that was identified in South Africa which the South Africans have named the 501Y.V2 variant - and I think it is important that we name these appropriately and we don't call these the South African variant or the UK variant. We need to use the names appropriately because we don't want to stigmatise where these variants have been identified. That's true for any virus that's identified.
With regard to the South African - the variant identified in South Africa, the 501YV2, I did clarify that statement with the UK earlier today in terms of the studies that are ongoing. There's no indication that the 501YV2 variant has increased transmissibility compared to the UK variant.
There are many studies that are underway in South Africa by South African researchers and scientists to look at the circulation of this variant, to look at the transmissibility, looking through epidemiology studies and modelling studies as well as doing laboratory studies to look at the neutralisation studies.
00:32:03
Those are ongoing and scientists are working very hard to understand that but there's no indication that it's more or less transmissible than the variant of concern that was identified in the United Kingdom. Thanks for that question.
FC Thank you. I would like now to invite Ashley Furlong from Politico to ask the next question. Ashley, are you with us?
AS Thanks for taking my question. The CEO of the Serum Institute of India has said that the COVAX facility probably won't receive any of the Oxford AstraZeneca vaccines until March or April this year. I wanted to know if the WHO agreed with that timeline and what that meant for many of the countries that are part of the COVAX AMC and are still waiting for their first doses of the vaccine.
FC Thank you, Ashley. I would like to invite Dr Swaminathan to take this question.
00:33:10
SS Thank you. The procedure for each of the vaccines as they are developed and to be supplied would be firstly going through the regulatory processes, going through a policy process and then obviously procurement distribution and going into vaccination programmes.
As we just saw, the Pfizer vaccine received an emergency use listing last week from the WHO. Today there's a recommendation from SAGE which is a policy recommendation on how this vaccine should be used and following this the vaccine can now be procured, distributed across the world in different countries including through COVAX.
As far as Serum Institute is concerned the COVAX facility has a contract with the Serum Institute for supply of both the AstraZeneca Oxford vaccine as well as the Novovax vaccine, of course when that becomes available; it's still in phase three clinical trials.
So we expect that this will happen as there is a contract, there is already a deal; the Serum Institute of India is in the process of manufacturing a large number of doses. They will be supplying the Indian Government obviously to start vaccination in India but we don't anticipate that there will be delays.
00:34:42
They are submitting a dossier for examination for the EUL and pre-qualification process later this week so that's going on under Dr Mariangela Simao's division. Therefore I think the February/March timeline is still very much what we're looking at in terms of being able to get that vaccine into COVAX and then distributing it out to the countries. Thank you.
FC Thank you, Dr Swaminathan. I would like now to invite Imogen Foulkes from the BBC to ask the next question. Imogen.
IM Hi, Fadela. Thanks for taking my question. Can you hear me all right?
FC Very well. Go ahead, Imogen.
IM [Inaudible] 2021. It's coming back to the recommendations around the Pfizer/BioNTech. When you say you could extend it for six weeks does that mean up to six weeks total from the three to four that you recommend or six weeks on top of the three to four?
In addition is there any risk that delaying or even abandoning the booster could promote a vaccine-resistant variant?
FC Thank you, Imogen. I would like to invite Dr Joachim Hombach of the SAGE secretariat, to take this question. Joachim.
00:36:13
JH Thank you very much for that question. When we mention six weeks this is actually the spacing between the first and the second doses so that's exactly how it has been defined and the six weeks, because this is the maximum time period for which at least some clinical data are available.
The clinical trial was designed around 21 days but there are up to 42 days or around six weeks of data so this is what has been essentially driving the recommendation that SAGE has formulated today.
In relation to the emergence of virus variant I think this is speculative. We of course do not know, if you administer just one dose, if there is durable immunity, how long it lasts so there is certainly a high risk of breakthrough infections but again this is an area where there's very little data.
We do not see a correlation with the emergence of virus variants but obviously there would be an increased concern in relation to breakthrough infections or vaccination failures. Thank you.
00:37:26
FC Thank you, Dr Hombach. I would like now to invite Pamela Mwanda from Uganda Radio. Welcome, Pamela. You have the floor. Can you please unmute yourself, Pamela from Uganda Radio? Pamela, we will come back to you later on. I would like now to invite Donato Mancini from Financial Times to ask the next question. Donato, can you hear me?
DO Hi, can you hear me?
FC Yes, very well. Go ahead, Donato.
DO Happy New Year. Could you clarify what the maximum time span is for the extended intervals, is it six weeks? Because this is exactly what the EMA's recommending in limited cases and it's also half of what the UK is doing. Who are these guidelines for and what are the specific circumstances in which you make allowance for this extended dosing regimen?
FC Thank you, Donato. I will ask again Dr Hombach to take this question.
00:38:49
JH Thanks very much for that question. Maybe I'll repeat myself a little bit in relation to my previous answer but the recommendation is to administer the second dose within 21 to 28 days and this is the label recommendation and this is where the bulk of the clinical data has been generated. There's always some variation and there has been spacing in the clinical trial up to 42 days and so this is where we have been setting the bond release.
The JCVI, which is the recommending body of the UK, has given more flexibility, up to 12 weeks in consideration of the specific circumstances that the country is currently facing, which Dr O'Brien explained already earlier today. So we feel that we need to be grounded in evidence in relation to our recommendations but totally acknowledge that countries may see needs and... in order to be even more flexible in terms of the administration of the second dose.
But it is important to note that there is very little empiric data from the trials that underpin this kind of recommendation. Thank you.
FC Thank you, Dr Hombach. Kate O'Brien would like to add some elements. Kate, can you hear me?
KOB Yes, thank you. I want to add a couple of things here. I think we have to emphasise the need for additional evidence because there is no recommending body, there is no entirety of the evidence that tells us the clear and full answer to these policy questions.
00:40:51
This is the nature of policy making, that we must make recommendations based on imperfect data and any particular group of people in a particular setting of epidemiology and disease transmission are going to collectively come to sometimes exactly the same decision of weighing the risks and the benefits and sometimes some adjustments to those decisions in one particular country, another particular country with different environments that they're making those in.
For WHO we're making recommendations that are broad underpinnings for all countries around the world and so SAGE in this particular decision fully recognise that the decisions that are being made, recommendations that are being made are interim and that we will continue to update those recommendations are more evidence accrues and we will point to the data that is making those adjustments.
00:41:54
So I really want to emphasise the need for ongoing generation of evidence and ongoing research and depending on what different countries do that evidence will come on extended intervals or on shorter intervals.
The second thing I want to say is that there's nothing about this that means that if an individual has had a delay for whatever reason in getting their second dose that they shouldn't go ahead and get it. There's no outside limit at which point we say, you can't get your second dose. I want to be clear also on that, that any of these statements about what the interval is between the two doses never precludes somebody from getting their second dose whenever they're able to get it even if it's an even longer extended delay for whatever individual reason. I just wanted to make those two points clear.
Then the third point I want to make is that we are really looking forward to evidence from other vaccines as well both for emergency use listing, regulatory purposes and for policy recommendations. The evidence that is used for regulating a vaccine and the evidence for policymaking are not always the same sets of evidence. The policymakers do really have to take into consideration the actual operational on-the-ground real-life circumstances, where practitioners, nurses, doctors, other types of vaccinators depending on the country have to make a decision about an individual who's right in front of them.
00:43:30
So we try as best we can to give clear recommendations that would guide an individual decision for an individual patient.
FC Thank you, Dr O'Brien. I would like now to invite Emma Farge from Reuters to ask the next question. Emma.
EM Good afternoon. I was wondering about the wastage of some of the Pfizer vaccines that we've been hearing about in some countries. Some of them after they've been cooled have actually been thrown away for lack of demand. How widespread is this, does the WHO have a view on it and what should be done to avoid wasting these precious vaccines?
FC Thank you, Emma; interesting question. Dr O'Brien.
KOB We're in the very early days for every country of rolling out vaccine. There have been hundreds and hundreds of vaccine introductions, in fact thousands of vaccine introductions that have taken place around the world over the past five years, ten years, 20 years.
00:44:50
The amount of attention that has been paid - of course and justifiably so - to the introduction of these vaccines is like no attention that has ever been paid to vaccine introductions before. The pace and the complexity of actually standing up these vaccine programmes is very high. They are in age strata that we don't normally do a really big, broad roll-out of vaccines in.
We have programmes that are much more able and experienced at rolling out in infants and in teenagers, especially with the Pfizer vaccine within ultra-cold chain, with the supply constraints and therefore really identifying who needs to be vaccinated.
I think it's extremely important to recognise, as we've been saying, that getting to the efficacy results and developing these vaccines and getting to the efficacy results; I think the analogy we've used before, that has been out there is like building base camp at Mount Everest but actually getting to delivery of this vaccine in all of the people who need it is the real climb to the peak of Everest.
So we're really in this space where we know that the delivery challenges are substantial and the attention, the time, the training, the funding, the planning that needs to happen to operationally roll out these vaccines in a way that is as highly efficient and is going at speed are real areas of tension and I think we're seeing those growing pains and those learning routes in these very early roll-out countries.
00:46:37
So what is most important here is that whatever is happening in countries and where we're hearing about the difficulties of delivery we're learning from those as quickly as possible and we're learning about what are the ways in which we can avoid some of these pitfalls as we move forward and especially as we move forward in an ever broader number of countries at a very, very rapid pace.
We don't have a full handle on the quantification of the magnitude of these problems and we very much welcome the transparency of countries to describe and explain what is going right and what's going wrong because unless we can understand what's going wrong it's very hard to course-correct from things that you can't see, can't measure or can't understand.
00:47:32
So I think this is, I would say, unfortunately a bit of an expected part of the challenges but if we look back at what experts around the world in all countries have been saying it's, nobody expected this to be easy. I think we're starting to see where some of those road bumps are and where we need to make adjustments.
FC Thank you, Dr O'Brien. I would like to invite Dr Simao to answer also the question.
MS It's just a piece of information because as we did the emergency use listing of the Pfizer vaccine we also did the emergency use listing of two syringes because it's a very complex vaccine; you already heard about that, because of the ultra-cold chain, the logistic challenges and so on.
But it also needs to be... It's a 0.3ml injection so we have prequalified two of these 0.3ml syringes so this will help to decrease wastage if it's happening. But I also want to say that we have a front-runner which was the Pfizer vaccine but we have other vaccines being assessed now by WHO.
We have received when we launched the expression of interest in October last year - it's already last year - we had received 15 expressions of interest; 13 were accepted; two of them were not accepted because we were not yet on phase two or phase three.
00:49:11
Since then we did list the Pfizer vaccine. We have two other dossiers being assets as we speak and we are expecting three additional dossiers from other vaccine producers during the month of January.
So we have in our hands right now a limited number of a complex vaccine with a high efficacy but we will have more vaccines coming up in the months of February and March this year. Thank you.
FC Thank you. Dr Ryan.
MR Yes, just to add from an operations point of view - and I very much agree with what Kate said - right around the world we have already stressed, understaffed and underfunded public health, primary healthcare, immunisation services who've been in the front line for the past year trying to deal with surveillance and testing and contact tracing and quarantine.
00:50:08
These same front-line public health services now have to absorb the job of doing the vaccination as well as part of the broader public health services. This requires generating, managing and sustaining demand, scheduling, micro-planning, the logistics of moving the vaccine around, making sure the vaccine reaches the person on the right day at the right time in the right place.
This is a complex process. It is resource-intensive, human and physical and financial resource-intensive. It's really important that national governments who are issuing vaccines and distributing vaccines to sub-national level are also aware of the investments that are needed to shore up the capacity of the system to deliver those vaccines at the local level.
You can't file and forget, you can't dispatch and forget, You have to drive and follow each vaccine right into the arm of the person who has to get it. We've learnt that in polio - I'm looking across here at Bruce - and measles and many other diseases and you've got to follow that chain of quality and efficiency, as Kate said, right the way down through that chain in the system.
Quite frankly many countries may have been overconfident in their ability to do that and have made some assumptions about their capacities that may not have existed. WHO is working very closely - and Kate or Joachim or others may come in on this - with 100 countries now on their micro-planning because one of the requirements of being part of COVAX is to work on that very process of delivering the vaccine, enabling successful vaccination.
00:51:41
That's why the COVAX initiative isn't just about getting vaccines, it's about delivering vaccines and delivering them to the people who most need them in an equitable fashion but most importantly efficiently with the lowest possible wastage.
So all countries really need to take a hard look at their capacity to deliver vaccines. Always at the beginning, as Kate says, we always falter at times at the beginning of a new procedure in public health; we always make some errors. The question is not making the errors; the issue is not learning from those errors and not extrapolating from those errors and realising that our systems are probably not strong enough right now to deliver this vaccine as efficiently as we would like and we need to invest.
WHO is doing that with our partners in COVAX, with our partners in immunisation programmes around the world but those immunisation programmes need the resources, they need the support, they need the man and womanpower to do this.
00:52:37
FC Thank you. Dr Aylward.
BA A quick point on the last part of the question that was asked about how you avoid wastage. The single best thing we can do is the planning right up-front. Mike was alluding to that a little bit and Kate isn't blowing her own horn on this but the WHO and UNICEF teams with others have done a fabulous job of putting together guidance for countries on the complex process of national vaccine deployment plans.
There's been an aggressive programme of work going on since the middle of November to help every one of the countries in the world with the weakest systems to be able to identify and address the obstacles and blockages they might have right now.
Because the motto that sits quietly behind the whole roll-out of the vaccine is no dose lies idle. That's the motto everybody's working towards so the single most important part of it has been that advanced planning, capacity building, training, etc, everything that Mike referred to and which has been a huge, intensive part of the roll-out work already even before the vaccines hit the ground.
00:53:45
Some countries, as you may have heard in the press; already people are reporting on the simulation exercises they're doing to make sure that they aren't wasting those doses and they're getting those into people as rapidly as possible because quite frankly these are going to save lives if they get to the people who are most vulnerable, the most high-risk of dying, if we can get them into them now.
Then this comes back to the point the Director-General was making; we have a lot of countries increasingly ready. We need the vaccines to be able to get these into those people and that's why we went out with a donation policy from the COVAX facility two weeks ago so that countries with many doses and access to many doses could provide those to some of the most vulnerable countries that need them.
00:54:28
As well that's why we're trying to fast-track the deals that are still outstanding with many manufacturers to try and make sure we have the products we need to take advantage of the readiness work that's been done.
FC Thank you all. I would like to invite, IFP, Robin Millar, to ask the next question. Robin, can you hear me? Robin, can you hear me? If not, Agnes from IFP? I would like now to... Agnes, can you hear me?
AG Yes, I can hear you. Do you hear me?
FC Yes, fine. Go ahead. We have two IFP reporters with us today.
AG Thank you very much. Good evening, everybody. I have a question concerning what Dr Tedros said on the mission, on the experts going to China. Something is not clear for me. You say that some experts already began to travel so they are en route, as we say in French, but at the same time you say you don't have the full authorisations. So I was wondering, where are those experts now?
FC Thank you, Agnes. Dr Ryan will take this question.
MR We have been working in very close planning with colleagues in China and other countries for the dispatch of the team and we were all operating on the understanding that the team would begin deployment today.
00:56:21
Two of the team - because they're coming from far away and through difficult journeys - had begun their journey previously, very early today and had begun their journeys but in the meantime it became clear that the necessary approvals had not been gotten.
It was specifically in regard to visa clearances and we did not want to put people in the air unnecessarily if there wasn't a guarantee of their arrival in China being successful. In that regard Dr Tedros has taken immediate action and has spoken with senior Chinese officials and has fully impressed upon them the absolutely critical nature of this.
We trust and we hope that this is just a logistic and bureaucratic issue that can be resolved very quickly and Dr Tedros expects that that will be the case and has emphasised the absolute need for this.
00:57:17
The two colleagues who have been travelling; one has been turned around and has a reasonably short journey home. The other will stay in transit in a third country awaiting further inputs from us. We would like to thank our experts for their flexibility in this. Many of them have carved out very precious time from their home institutions and we thank their home institutions for this.
This is frustrating and, as the Director-General has said, this is disappointing. That disappointment has been expressed very clearly by Dr Tedros directly to our counterparts in China and we trust that in good faith we can solve these issues in the coming hours and recommence the deployment of the team as urgently as possible.
FC Thank you, Dr Ryan. We have gone over one hour since we started this press conference so I would like to invite Dr Tedros to make final comments. Over to you, Dr Tedros.
TAG Thank you, Fadela, and thank you all who have joined today. I think some of you have complained about the delay in our starting the presser so apologies for that; we will improve. But thank you for joining and Happy New Year again and see you in our upcoming presser. Thank you.
FC Thank you, Dr Tedros and Dr Cravioto and colleagues for your participation. We will be sending the audio file and the DG's remarks after this press conference. The full transcript will be available tomorrow on the WHO website. If you have any followup questions please do send an email to mediaenquiries@who.int
The press briefing is now closed. Thank you.