Virtual Press conference on global health issues transcript - 8 February 2023
Overview
00:01:08
CL Hello
and welcome to WHO and today’s virtual press conference on global health issues
but also an update, of course, on the earthquake in Türkiye and the Syrian Arab
Republic. My name is Christian Lindmeier and I will take you through today’s
press conference. We’re here, in the WHO Headquarters in Geneva. Now, simultaneous
interpretation is provided, as usual, in the six official UN languages, Arabic,
Chinese, French, English, Spanish and Russian, as well as Portuguese and Hindi.
Now, to the quite large panel. Here, in the room
with me, are Dr Tedros Adhanom Ghebreyesus, WHO Director-General, Dr Mike Ryan,
Executive Director for WHO’s Health Emergencies Programme, Dr Bruce Aylward, he’s
Senior Advisor to the Director-General and the Lead on ACT-Accelerator. Then,
we have Dr Sylvie Briand, Director for Epidemic and Pandemic Preparedness.
00:02:08
We also have Dr Adelheid Marschang, she’s Senior
Emergency Officer, and Mr Rob Holden, the Incident Manager for the Earthquake
Response, as well Ms Linda Doull. She’s Global Health Cluster Coordinator. Also
on the line, I’m very glad we have a number of other
colleagues who we’ll get to when we get to the topic.
But a
special welcome also to the Head of Country Office in Türkiye, Dr Batyr
Berdyklychev, excuse my pronunciation, and Dr
Iman Shankiti. She’s the WHO Representative in the Syrian Arab Republic. With
this, I’ll hand over to the Director-General.
TAG Thank
you. Thank you, Christian. Good morning, good afternoon and good evening. I
want to start by expressing my deepest condolences to those affected by the
earthquakes that hit Türkiye and the Syrian Arab Republic in the early hours of
Monday morning. So far, almost 8,000 people have died, many thousands more are
injured and we know these numbers will climb.
With the weather conditions and ongoing
aftershocks, we’re in a race against time to save lives. People need shelter,
food, clean water and medical care for injuries resulting from the earthquake,
but also for other health needs. WHO has released US$3 million from the
Contingency Fund for Emergencies for the response in both countries. WHO is
providing medical supplies, supporting both countries to respond, and working
with partners to provide specialised medical care.
00:04:06
One flight is currently on the way to Istanbul,
carrying medical supplies and surgical trauma kits from our logistics hub in
Dubai, in the United Arab Emirates. Another flight to Damascus is almost ready
for departure, and a third flight is being planned. We are also sending a
high-level delegation to coordinate our response.
In addition, 77 national and 13 international
Emergency Medical Teams are deploying to both countries. Emergency Medical
Teams are made up of health professionals from around the world who are trained
to provide life-saving care in emergency situations. Today, we’re joined by WHO
representatives from both countries to tell us more about the situation on the
ground and the needs they are facing. First, to our WHO representative in the
Syrian Arab Republic, Dr Iman Shankiti. Dr Shankiti, you have the floor.
IS Thank
you. Thank you, DG. Good afternoon to all of you. As Dr Tedros has already said,
the country has been hit by a 7.8 earthquake on Monday and it is really
important to note that numbers of people affected, whether it’s deaths or
injuries, are rising as per the hour. Right now, we are at 62 hours and having
very harsh conditions, weather conditions. The possibility of finding live
casualties is diminishing and more and deaths are being reported.
As far as the last report from the Ministry of
Health, we have more than 2,054 injuries and 1,250 deaths and this is from four
governorates, Aleppo, Latakia, Hama and rural Idlib. We continue to be very concerned
about areas which are inaccessible because of the earthquake, which has
destroyed some of the areas there which are used for transportation.
00:06:23
Definitely, the health needs are tremendous.
It’s important to note that the health system has suffered for the last 12
years and continues to suffer and continues to be strained by the ongoing
emergencies, and the last one is this earthquake. There are a lot of efforts ongoing,
whether it is from communities or civil societies, for search and rescue and,
definitely, patients continue to arrive to hospitals.
We are still assessing hospitals and access to
services and we are trying to notify several hospitals that have structural
issues if they could tell us if they have patients and might not be accessible
in the near future. WHO currently is focusing on areas like trauma care and
life-saving interventions and, of course, ensuring continuity of care and essential
health services, specifically focusing on areas that are affected by the
disaster.
WHO has provided during the last 24-48 hours,
and this is using the stocks that we have in Aleppo and in Latakia and stocks
we have in Damascus, we have provided already medical supplies and treatments
that are enough for 300 trauma cases and more than 100,000 treatments for
patients arriving to hospitals. And, also focusing on water because we are
concerned about is the water quality at this stage. Water disinfection tablets
have also been dispatched and distributed. More than half a million tablets
have been dispatched and distributed in Aleppo, Homs, Hama, Tartus and Latakia.
00:08:12
We are receiving two cargoes, as DG said. It was
supposed to arrive tonight but, due to a technical problem, it will arrive
tomorrow. And there’s another one that will arrive a day following and it’s
really focusing on trauma kits and trauma care, and it should be able to cater
for more than 10,000 cases in facilities.
I would like to focus on the immediate needs and
priorities needs now because what’s important to focus is on a holistic
approach and, of course, search and rescue is one of the major components but
access to shelter, to food, to water is going to be key and, of course, access
to health services or continuity of care.
IN Unfortunately
the choppy sound is making it very difficult for interpreters to interpret.
CL Dr
Shankiti, maybe we could ask you to turn off the video. Maybe that improves the
sound quality. Apologies for this, everyone. Let’s try without video. Just
audio, please.
IS Done.
CL Thank
you.
IS Where
do you want me to start? Can I start just with the immediate needs and key
priorities?
CL Yes,
very good.
00:09:37
IS Because
what we need to do is have a holistic approach addressing the immediate needs.
Search and rescue is one of the immediate needs, but also access to shelter, to
food, to water and continuity of care is going to be key in the next two weeks
and, of course, the replenishment of the supplies. These are all immediate,
urgent needs.
What follows is something larger in terms of the
facilities that have been affected and to support the reactivation of the
health system, which has already been very much affected during the last couple
of years as per the reports. More than 50% of the facilities are not
functioning and the rest are partially functioning. So, with that, I leave it
here and thank you, DG, for giving us the chance to put our case in front of
everyone. Thank you.
TAG Thank
you. Thank you, Dr Shankiti. Now, to our WHO representative in Türkiye, Dr
Berdyklychev. Dr Berdyklychev, you have the floor.
BB Thank
you very much, DG, and greetings to everyone. I apologise for the quality of
connection. I’m currently on the field mission to Gaziantep and Adana. It’s the
south of Türkiye. And, if you allow me, I’ll switch off the camera, just to
restore a better connection.
CL Yes,
please. Thank you very much.
BB Thank
you. A brief update from my side. It has been 62 hours since the first impact,
first earthquake happened on the 6th February morning which was followed by
another one, and then numerous aftershocks. I’ve just been to our office in Gaziantep
and aftershocks are continuing, which brings a lot of challenges for the search
and rescue operations.
00:11:46
In total, the earthquake affected ten provinces
with the population approximately 15 million. Government immediately announced a
Level 4 disaster, which triggers international assistance and yesterday the
State of Emergency was declared in the affected provinces. Unfortunately, the
number of deaths and injured people continue to grow and, as of now, we have
more than 9,000 deaths and more than 53,000 injured people.
The main challenges at the moment is continuing
aftershocks, bad weather, sub-zero during the night time. Also, damaged roads
which hinders access to the affected territories and areas. Also, the
challenges for search and rescue due to the magnitude, magnitude of the event
and number of affected cities and provinces. Also, trauma care and mental
health and psychological support.
As I also already mentioned, government launched
a massive response, deploying more than 92,000 personnel and we are closely
coordinating with the authorities, our assistance. As of now, we are expecting
landing of a charter flight with trauma kits arriving to Türkiye today for
further distribution of those kids to the affected population in Türkiye but
also in north-west Syria.
We also have a WHO mission arriving today and
tomorrow to Adana and Gaziantep to coordinate the work of an EMT coordination
cell, which has been established by the Ministry of Health in Adana. Another
update, the road to north-west Syria has been restored through one of the
cross-border points, which would facilitate transmission of kits and supplies
we have in our hub warehouse in Mersin. In general, we are on standby and
coordinating all activities with the national authorities and also guided by
the response from their side. This is briefly it from my side. Thank you very
much for your attention.
00:14:26
TAG Thank
you. Thank you, Dr Berdyklychev. Thank you so much. And, as Dr Shankiti said,
the situation in the Syrian Arab Republic is compounded by years of conflict
and outbreaks of measles and cholera, which were already posing a huge
challenge to the fragile health system.
Since late August, about 85,000 cholera cases
have been reported from the Syrian Arab Republic, but it’s just one of 30
countries that reported cholera outbreaks last year. Around the world, we
estimate that more people died from cholera last year than in the previous five
years put together. Currently, 23 countries are experiencing cholera outbreaks and
a further 20 countries that share land borders with affected countries are at
risk. In total, more than one billion people around the world are directly at
risk of cholera.
Cholera spreads through contaminated water, so
clean water is needed urgently, wherever there is an acute outbreak, to prevent
transmission. WHO also strongly recommends countries at risk of cholera
outbreaks to scale up surveillance so cases can be identified and managed as
quickly as possible.
There are effective vaccines for cholera but,
with supply very limited, the International Coordinating Group that manages the
global cholera vaccine stockpile last year suspended the standard two-dose
regimen, recommending instead a single-dose approach to extend supply. In the
medium to long-term it remains important that global vaccine production is
increased. In the meantime, we must rely on other measures to stop outbreaks
and save lives.
00:16:24
Over the past few weeks there have been several
reports of mammals including minks, otters, foxes and sea lions having been
infected with H5N1 avian influenza. H5N1 has spread widely in wild birds and
poultry for 25 years but the recent spill over to mammals needs to be monitored
closely.
For the moment, WHO assesses the risk to humans
as low. Since H5N1 first emerged in 1996 we have only seen rare and
non-sustained transmission of H5N1 to and between humans, but we cannot assume
that will remain the case and we must prepare for any change in the status quo.
As always, people are advised not to touch or
collect dead or sick wild animals but to report them to the local authorities.
WHO is working with national authorities and partners to monitor the situation
closely and to study cases of H5N1 infection in humans when they occur.
WHO’s global laboratory network, the Global
Influenza Surveillance and Response System, identifies and monitors strains of
circulating influenza viruses and provides advice to countries on their risk to
human health and available treatment or control measures. WHO recommends
countries strengthen surveillance in settings where humans and farmed or wild
animals interact. WHO is also continuing to engage with manufacturers to make
sure that, if needed, supplies of vaccines and antivirals would be available
for global use.
00:18:26
Finally, new research has found that less than
half of children are breastfed exclusively for the first six months of life,
which is WHO’s recommendation. Many women lack the support they need to
breastfeed, with over half a billion working women globally lacking adequate
maternity protections. Meanwhile, misleading formula milk marketing claims
undermine breastfeeding at every turn. Almost every country has signed the
International Code of Marketing of Breast-milk Substitutes, which restricts
marketing of formula milk. However, regulations are largely unenforced.
WHO is calling on governments and policymakers
to promote breastfeeding by ensuring all women have adequate maternity
protections, ideally at least six months paid maternity leave, as well as time
off for breastfeeding when they return to work. We also continue to call on
governments to end exploitative marketing of formula milk and increase health
sector support for breastfeeding so that all families have access to reliable
information and advice before and after birth. Christian, back to you.
CL Thank you very much, Dr Tedros. With
this, we open the floor for questions. Let me remind you, in order to get into
the queue, please raise your hand with the Raise Your Hand icon and unmute
yourself when it’s time to go. We’ll start with Erin Prater, from Fortune.
Erin, please go ahead and unmute yourself.
00:20:17
EP Thank you so much. I appreciate it.
This question already been partially addressed. I was going to ask for an
update on H5N1 but, in any case, what is status of the Ecuadorean girl who was
recently sickened and the epidemiological investigation there? Have there been
any additional cases identified in that country or elsewhere? And what do we
know about how H5N1 in humans, the severity of it may compare to the Spanish
flu? Thank you.
CL Thank you very much, Erin. We’ll start
with Dr Sylvie Briand. She’s Director for Epidemic and Pandemic Preparedness
and Prevention.
SB Thanks a lot for your question. First,
to reassure. Since those cases, we have had no more human cases with H5N1 in
the recent days. Those cases are quite rare and they are due to the direct
exposure of humans to infected animals. This is why it is important when there
is a place where you have epidemics in animals of aviation flu, it’s important
to make sure that people don’t touch dead animals or try not to be exposed to
animals that are sick with the avian flu.
With regard
to the risk, I think what is very important to understand is that so far the
circulation of these viruses in animals, it’s a zoonotic virus and therefore
the virus is very adapted to animals and not to humans. So, when we have an
infection of a human, usually it’s first only one individual. There is rare
transmission to other humans unless they have very, very close contact or a
very specific condition for transmission.
00:22:22
And so, so
far, because of the characteristics of the virus, we need to be just vigilant
to make sure that the spread in animals is contained because the more the virus
circulates in animals, the higher is the risk for humans as well, because the
virus circulating in animals can evolve to forms that are more transmissible
and then, if there is a spill over in human population, then we can have
outbreaks of avian flu.
So, I think
it’s very important to really understand where is the virus in animals, and
that’s why collaboration with animal health agencies like FAO and WOAH are
really important because they monitor the virus spread in animals and monitor
also the geographic distribution of these viruses in wild animals but also in
domestic animals so that we can control the spread and prevent spill over to
humans.
CL Thank you very much.
MR Can I just supplement, just in terms of
the specific question regarding Ecuador? The young person, the latest report as
of yesterday or this morning was that that young person is improving and there
are no further cases detected amongst the contacts of that person. So far, this
is considered to be a sporadic case with direct exposure to the virus in
poultry, which is reflecting that pattern of spread.
But, as
Sylvie said, the geographic extension of the problem amongst avian species, the
shift of those viruses into small mammal species who can process that virus
quickly and the virus can evolve, and then the association with humans, either
in an occupational or a backyard environment, always creates the chance that
this virus can evolve.
00:24:21
I think we’d
like to thank our partners around the world in the Global Influenza
Surveillance and Response System. Those people work tirelessly in labs all over
the world every day, every night, sharing specimens, analysing the genomics,
looking at the antigenic characteristics of these viruses and developing
candidate vaccines from time to time to make sure that our vaccine defence is
up to scratch with the circulating viruses. So, there’s a lot of work that goes
on in the background.
As Sylvie
said, people should not be alarmed. In this case, I think public health
authorities are doing what they should be doing to carry out surveillance.
There are issues that we need to address at the animal-human interface and
biosecurity on the animal side of the equation, and that’s why we need and are
working much more closely with our colleagues in FAO and OIE.
Protecting
humans isn’t only about managing viruses in humans, it’s about managing viruses
in the animal kingdom and especially at that animal-human interface where
animals and humans come together. It can be managed and the risks can be
reduced and it takes a lot of investment at community level.
We sometimes
think solutions lie in technology, and they do, and maybe in innovation and
maybe in developing vaccines and maybe in doing all of these things and, yes,
we need to do that. But the frontline of pandemic prevention is in our
communities. That’s where the risks are reduced.
00:25:49
And if
communities have the opportunity and the education and the investment and the
knowledge, they can be the true partners in pandemic preparedness. So, it’s
really important as we look to these threats that we don’t just always
automatically knee-jerk ourselves into having technological solutions.
We need those
but what we need is actually frontline, community preparedness, participatory
surveillance and investments in our communities’ resilience so they can detect
and report these incidents and we, in public heath, can support the risk
reduction process.
CL Thank you very much, both. Next
question goes to Belisa Godinho, from W Magazine. Belisa, please go ahead.
BG Thank you for taking my question. What
is the status of the WHO in Ukraine at the moment? Thank you.
CL A very general question. Maybe we want
to ask Dr Mike Ryan.
MR In terms of WHO, our response continues
to be very highly developed in Ukraine, right across the territories, working
very, very closely with the health ministry there. We have hundreds of health
partners there.
I don’t know
if Linda would like to comment on the health cluster in Ukraine, which is a
major partner in terms or our NGO and INGO partners who work with and through
the Ministry of Health. We continue to provide critical supplies, work with
surgical and medical training, and increasingly working with Ukraine on issues
like surveillance, public health management and rebuilding immunisation and
other services.
00:27:40
The latest
events in Türkiye and Syria clearly put strain on all our system and, again,
we’d like to thank our partners, both our financial partners and our
operational partners for once again coming to the assistance of the people of Türkiye
and Syria while sustaining our responses in Ukraine. The winter in Ukraine is
having, and we see this any time you have a crisis, whatever the source of that
crisis you will see the impact that the environment, weather has. We see the same
in Türkiye and Syria.
What we do
see and what’s common in both of these situations is the devastating impact of
war and conflict on the health system, on the health and wellbeing of ordinary
civilians and the reality is it doesn’t matter what takes a building down, 7.9
degrees on the Richter scale or a missile. At the end of the day, it’s human
bones that are crushed, it’s human children that are killed.
And we really
need to speak today to the bravery of those workers in the frontline who
continually, in Ukraine, and in Syria, and in Türkiye are going into buildings
at the risk of their own lives, rescuing who they can rescue and bringing them
to medical assistance. It’s really important that we’re able to link the health
services to the trauma and wounds that people suffer but the reality is the
situation in Türkiye and Syria in terms of the earthquake is largely
unavoidable. The realities underlying the crisis in Syria and the crisis in
Ukraine are avoidable. Thank you.
00:29:20
CL Thank you very much, Dr Ryan. Next
question goes to Banjot Kaur, from The Wire in India. Banjot, please go ahead
and unmute yourself.
BK Hi, Christian. Thanks for taking my
question. In one of the recent press conferences WHO kind of issued a renewal
alert on the three product alerts against cough syrups. Could you please give
an update as to what has been the investigation so far about all the three or
four events and what has been the understanding so far about all these three
events? Thank you.
CL Banjot, thank you very much. I believe
we have Dr Rogério Gaspar with us online. He is Director, Regulation and
Prequalification. Rogério, if you’re there, please go ahead.
RG Yes, certainly. Regarding the question
that was put now. As you know we have three alerts that were issued on the
incident in The Gambia, in Indonesia, and also in Uzbekistan. They are
different incidents looking at different manufacturers, different products,
with different active substances and they have all in common that they the same
pharmaceutical dosage forms and they are used normally in paediatric use, for
children.
The
fatalities that we have registered in those three countries are over 300 deaths
over a period of four months and children of very low age, below seven years old.
The issue was already addressed several times and there was a declaration also
from the DG in the name of WHO that was published some time ago.
00:31:11
And our
identification of the problem is very clear right now. We have issued a
recommendation for Member States, for national regulatory agencies, for
manufacturers, for healthcare providers. That was already published. I’m not
going to repeat all of it, but our main concern right now is about the supply
chain of excipients for those pharmaceutical dosage forms. This is our main
concern and this is why we issued an alert, a global alert because, as you
know, excipients are not as regulated as pharmaceutical products.
We are taking
a number of approaches at the same time which involve national regulatory
authorities in the counties to pursue the investigation, but we are also
developing a number of lines of action in terms of consolidating and
reinforcing the regulatory oversight, looking at the excipients that might
eventually occur in the future in similar cases. So, probably, for now this is
everything I would like to report at this moment in time. If any other detail,
I could answer directly. Thank you.
CL Thank you very much, Dr Gaspar. Let me
remind journalists who have their hand up, but we can’t read your names or you
haven’t even put the outlet, please rename yourself in the system. This way we
can possibly take your question. We cannot if we cannot identify yourself
because we see two or three who have their hands up but, again, we can’t
identify you. Next question goes to John Zarocostas, from The Lancet. John,
please go ahead.
00:32:46
JZ Good afternoon. I would like to get
your comments on this Sunday, 12th February, will be the first International
Day for the Prevention of Violent Extremism and I’d be interested in what WHO
is doing in terms of integrating mental health and psychosocial support in
countries affected by violent extremism, and especially to rehabilitate people
who have been through traumatic experiences. Thank you.
CL Thank you very much, John. We go to Dr
Ryan.
MR Yes, John. Certainly, between one and
four and one in five people living in conflict or violent situations experience
significant mental and psychological disturbance, many of which lead to
psychiatric conditions. Not only that, people with existing mental health
conditions are often the least served when it comes to those health services
during conflict. So, there’s a two-way process here.
WHO has
worked very, very hard with our partners in the UN system and in the broader NGO
community on a minimum service package for mental health and psychosocial
support in emergency countries. That is becoming now a standard practice right
across the UN system in terms of health emergency appeals, in terms of
humanitarian implementation plans. The mental health and psychosocial support
are becoming part of that core package.
In fact,
we’ve been working with our partners to make that a required part of our
package in order to seek humanitarian funding, especially from funds, from emergency
relief funds. So, yes, John, it’s a huge issue. Thank you for raising it and
for the hundreds of millions of people around the world who live in conflict it
is not only their physical health that’s at risk, their mental health is at
risk too.
00:34:44
But we also
see that now in the aftermath of this crisis in Syria and Türkiye, the
psychological stress that communities have gone through in the last 60 hours
will reverberate for 60 years, 60 months and, in the case of some families, for
years and generations and that will have its own psychological impact.
Equally,
during COVID, one in three to one in four health workers, frontline health
workers in the aftermath of COVID, has had a diagnosable psychological and
mental health condition like post-traumatic stress. So, I think no matter what
the emergency, both communities and health workers and frontline workers are
put under massive stress and was said, I think, earlier, we need to take care.
I think it
was Margaret I heard on the TV earlier saying that we need to make mental
health part of our first response, not part of our last response. I was really
glad to hear her saying that today because I think it’s the most important
statement I heard today. Adelheid or Linda, would you like to comment on the
issue of mental health and psychological stress in crises? Bruce.
BA Thanks, Mike. And, John, thanks for
the important question. One thing I’d just highlight, further to the points
that Mike made, is that WHO has a long history in this area now and, in fact,
published the Psychological First Aid Guide for working in such areas back in
2011 and has continued to build on that work, and even some of the work
predates that.
00:36:22
So, I just
wanted re-emphasise, there are some very effective, very simple tools that can
be applied in any environment to address some of the challenges that you
highlighted in your important question. Thanks.
CL Thank you very much, both. Now, it
looks like we don’t have hands up of those we could identify, so let’s use the
opportunity that we have our special guest and also, here, a strong panel of
colleagues working on the earthquake emergency right now in Türkiye and the
Syrian Arab Republic. So, let me start with Dr Adelheid Marschang, maybe to say
a few words, an overall evaluation of the situation in those two areas.
AM Thank you, Christian, and as you have
all seen we have had the frontline responders on the ground from the first
hour. WHO has a longstanding presence in both countries that have now been
severally affected by the earthquake and, therefore, the ability to scale up the
response as per the needs is swift and agile despite some very, very clear
challenges and constraints.
So, we are
scaling up the response to meet the additional requirements in addition to the
longstanding humanitarian needs that we have seen in the region and have, at
the same time, a clear concern that besides the immediate health effects that
we are seeing and that we have heard of today and yesterday and throughout
since Monday, that there is a secondary health crisis emerging in the aftermath
as underlying health risks will likely be exacerbated.
00:38:21
I’m speaking
about and especially in the case of Syria. There are real diseases, including
cholera, respiratory illnesses, leishmaniasis, physical and mental trauma and
disability, secondary wound infection, etc. And the worsening of chronic
conditions, non-communicable diseases due to the disruptions of continuity of
care and the capacity to treat ongoing regular health issues. And, as I’ve seen
myself, these capacities have been gravely affected due to the longstanding
pre-existing complex crisis.
CL Thank you very much and we can move to
Mr Rob Holden, Incident Manager for the Earthquake Response, and maybe if we
have a moment also to focus on the logistical challenges we’re facing right
now.
RH Christian, thank you. Just to build on
the point that Adelheid made and, obviously, the DG made in his opening
comments. Both our WRs have quite rightly said we’ve got an immediate focus
here of life-saving but, at the same time, we’ve got an imperative to make sure
that those that survived the initial disaster continue to survive going forward,
and we can’t reinforce that point enough.
We have got a
large, unfolding and huge-scale disaster unfolding on us with large
geographical spread. We’ve got a lot of people who have survived now out in the
open and in worsening and horrific conditions. We’ve got major disruption to
basic water supplies. We’ve got major disruption to fuel, electricity supplies,
communication supplies, the basics of life.
00:40:07
We are in
real danger of seeing a secondary disaster which may cause harm to more harm to
more people than the initial disaster if we don’t move with the same pace and
intensity as we are doing on the search and rescue side. We’ve got to ensure
that people have the basic elements to survive the next period. We need to get
services up and running again. We need to make sure that people can get
immediate access to those services over a large geographical area.
This is no
easy task by any stretch of the imagination. You’ve heard what the government
in each of these countries is doing. The scale of the operation is massive and
I mean this would outstrip any country and any government in the world, but
what we’re seeing on the ground, even though it is still a confused picture, is
a sense of purpose and a sense of focus. And that focus isn’t just about search
and rescue. That focus is about ensuring people continue to survive and have
what they need to be able to do so.
CL Thank you very much, both. With this,
I think we are coming close to the end. Hang on. We have Erin Prater with a
follow-up question, if we are in the mood. Yes, we are in the mood. Erin,
please go ahead.
EP Thank you so much. I just wanted to
loop back on the final part of my question. Obviously, avian flu has avian
origins, the Spanish flu, I’ve read it was also thought to have avian origins,
and both viruses contain genes that allow them to replicate efficiently in
human bronchial cells according to the Population Reference Bureau.
00:41:49
I’ve also
read that H5N1 can lead to inflammation or lung cells becoming intensely
inflamed and a similar effect was noted in Spanish flu victims. So, again, can
you compare H5N1 in humans to Spanish flu and, again, elaborate on what threat
that H5N1 might pose to humans if there were to be a crossover and sustained
transmission among humans? Thank you.
CL Thank you very much, Erin. A really
good follow-up. So, we go to Dr Briand, please.
SB Thank you. Sorry, I didn’t address the
end of the question. I think currently H5N1 is a zoonotic virus, which means
that it’s adapted to the animal population, especially birds, and birds have a
different type of metabolism than humans. So, it circulates very well in birds
and now we see that it can also circulate in mammals, small mammals.
So, it means
that the virus starts to be adapted to different species but not yet adapted to
the human species and this is why, currently, the transmission from animals to
humans is rare and when it infects humans, further transmission between humans
is not easy because the virus is not well adapted to the human population.
As a zoonotic
virus, what we see usually with a zoonotic virus is very high mortality in
infected people because the virus is not well adapted, so when it enters the
lungs it does a lot of damage. And so that’s why cases are usually more severe
with zoonotic viruses, but the transmission is usually low.
00:43:46
And this is
what we have seen with H5N1 viruses so far, not sustained transmission in
humans, but when humans are infected, they are more likely to have severe
disease. And so, when we look at the case fatality ratio due to zoonotic
influenza, of course we are scared because it’s quite high, it’s between 30-50%
case fatality ratio but, again, those viruses are not very transmissible.
For the
Spanish flu, it’s slightly different. Of course, it was a virus with avian
characteristics as well but when the Spanish flu pandemic started the virus had
acquired already the characteristic to be easily transmissible between humans
and so the transmission was high and then a huge number of cases.
In 1918, it
was during the First World War, so there was a very specific condition to
facilitate the transmission of the virus and then also a very specific
condition that increased the seriousness of the disease because people were in
war, not very well nourished, a high density of military in the trenches, etc.
So, the conditions were really conducive for high mortality due to this virus,
although the case fatality at that time was variable, depending on the
circumstances, but not more than 4%.
But, because
there were so many cases, the crude number of deaths was very high at that time
and also, it’s worth to highlight that in 1918, during this pandemic, we didn’t
have antibiotics, we didn’t have antivirals either, we didn’t have vaccines,
and we didn’t have any of the tools that we have now to control influenza
outbreaks.
00:46:02
So, we are
much better placed, of course, now than one century ago but, still, avian flu is
a worry for a human population and that’s why we need to be very vigilant with
the circulation of H5N1 in birds and now the infection in small mammals because
we need to be ready to face outbreaks in humans and be ready, also, to control
them as soon as possible so that the virus doesn’t spread any further.
MR If I could just add, the virus that we
have in seasonal flu, one of the viruses circulating still is the pandemic
strain from 2009. So, our history of pandemics is that we have a massive
pandemic, it occurs in waves, the waves get smaller, eventually we get some
respite for maybe a couple of years but still low levels of disease, and then
we get a new pandemic strain.
So, the virus
drifts for years and then there’s a shift. To use that terrible analogy, it's
like an earthquake. The virus shifts significantly and then it’s a real lottery
at that point because if the virus adapts quickly then it can start a pandemic,
but most of the viruses are dead ends.
And the more
opportunities we give the virus, the more chance that one of those won’t be a
dead end, that one of those viruses will have the attributes that allow it to
transmit further. So, the less opportunity we give the virus to transmit to
mammals from birds, the less opportunity we give to the virus to transmit from
small mammals and birds to humans, the less chance the virus has of developing
those characteristics.
00:47:42
Viruses adapt
to the host they’re in. If we don’t become a host for the virus, then our risk
is much lower. It is risky at the moment that small mammals and, again, the
biosecurity of farming and trade in live small animals has to be very carefully
thought out. We’ve done a lot of work globally on food safety and hazard
analysis and controlling the critical points in the food chain.
I think we’re
still well behind on some of the biosecurity issues around the small animal
side of things. These small mammals, they may not look like us, but they’re
very like us when it comes to their basic physiology. That’s why you see very
often drugs are tested on animals. Why? Because those animals represent a
similar physiology to ours.
In the same
way, nature does the same thing. Nature has its own pharmaceutical platform in
which it can test all kinds of combinations. That is the way of the world. It
is not a bad thing. It is nature. It is ecology. It is evolution. Our job is to
stay one step ahead, be smarter.
That’s why,
again, we have 154 labs all around the world in the Global Influenza
Surveillance and Response network in countries, funded by countries who share
data 24 hours a day, collect samples, test those samples, do genetic
sequencing, compare those samples, if needed develop candidate vaccines.
That’s what
we need, not to be scared of the viruses. They’re out there. They will always
be there. What we need to focus on is our game plan for what we need to do to
ensure we keep everybody safe, and that’s why we need a fundamental
reinvestment in pandemic preparedness, pandemic surveillance and pandemic
readiness.
00:49:25
I think it’s
really, really important that we don’t spend our time just thinking of the
risks. What we need to do is act upon those risks because they can be
significantly reduced in terms of the chances of a pandemic occurring and also
in terms of its impact.
CL Thank you both very much for this free
class. We are close to the end, but I want to ask our Heads of Country Offices
in the affected regions if they want to say any final words before I give it back
to the Director-General. Do we have anybody out there still listening, either
Dr Shankiti in the Syrian Arab Republic or Dr Berdyklychev in Türkiye, who
could come online?
IS Thank you, Christian.
CL Thank you.
IS Actually, I wanted just to highlight
a few things which were also mentioned by Mike, and that’s the mental health
and the psychosocial. What is striking right now is that we have a lot of
children that have lost their families and it has been reported that these
children are in distress, first of all due to the experience that they have
faced during the earthquake and also because of their losses.
00:50:45
What is also
being reported by the community and by people in Aleppo and in Hama is that the
devastation that they are facing now is at a scale they have never faced
before. For the last 12 years, despite all the disasters or all the challenges
they have faced, this is the largest in terms of the impact on everyone. So, I
urge all of us, really, to put our heads together and to see how we can alleviate
some of the suffering of the people who have been affected by the earthquake.
Thank you so much.
CL Thank you so much, Dr Shankiti, for
this statement. Dr Berdyklychev in Türkiye, are you there?
BB Yes, thank you. I would like just to
refer to the severity and magnitude of this disaster both countries are facing
and the complexity of the response it requires. At the country level and at all
other levels of the organisation we activated all necessary mechanisms and are
fully operational.
I just would like to thank all the partners
and donors for their support because there is immediate need but there would be
also growing need because at the moment, we probably don’t know the real
magnitude of this unprecedented event. Thank you very much.
CL Thank you very much, both of you. With
this, I’ll give it back to Dr Tedros, WHO Director-General, but remind you that
we will send the remarks and the audio files right after this press briefing,
and the transcript tomorrow in the course of the day. Dr Tedros.
TAG Thank you. Thank you, Christian. I would
like to again express my deepest condolences to those affected by the
earthquakes that hit Türkiye and the Syrian Arab Republic. I also would like to
thank our two colleagues, Dr Shankiti and also Dr Berdyklychev, for joining us
and also for your hard work. You are not alone. We will continue to support
you, but thank you so much for all that you are doing. Finally, my appreciation
to members of the press for joining us today and see you next time.
00:53:19