ウィスパリング同時通訳研究会コミュのMedia briefing on monkeypox with Dr Tedros

00:02:14

CL Hello and welcome, finally, to our update on the report of the second meeting of the IHR Emergency Committee regarding the multi-country outbreak of monkeypox. It is Saturday, 23 July, shortly after four o’clock, 16:00, in Geneva now. And welcome to WHO and this Extraordinary Virtual Press Conference.

Just to flag, because of the special situation, we will not have interpretation today, on this Saturday, so it will be English only, please. Thank you very much. And apologies again for the longer delay we just had, and thank you very much for joining us on a Saturday afternoon or morning or evening, wherever you are in the world.

With this, let me introduce the participants. Present in the room here are Dr Tedros Adhanom Ghebreyesus, WHO Director-General, Dr Mike Ryan, Executive Director for WHO’s Health Emergencies programme. We have Dr Catharina Boehme, Chef de Cabinet at WHO. We, of course, also have Dr Rosamund Lewis, who is the Technical Lead on Monkeypox.
00:03:28

We have Dr Maria van Kerkhove, who is the Technical Lead on COVID-19. We also have with us Tim Nguyen, who is the Unit Head for High Impact Events. And we have two colleagues online for you, and that’s Dr Meg Doherty, who is the Director for the Global HIV, Hepatitis and STI Programmes, and Dr Rogério Gaspar, who is Director for Regulation and Prequalification.

A word on the expected statement that we’ll try to send out as soon as possible. We will send the DG’s statement which you’re about to hear as soon as possible after it’s been delivered. So you can then get the written version as soon as possible after it has been delivered. And with this, Dr Tedros, the floor is yours.

TAG Thank you, Christian. Good morning, good afternoon and good evening. A month ago, I convened the Emergency Committee under the International Health Regulations to assess whether the multi-country monkeypox outbreak represented a public health emergency of international concern.

At that meeting, while differing views were expressed, the committee resolved by consensus that the outbreak did not represent a public health emergency of international concern. At the time, 3,040 cases of monkeypox had been reported to WHO from 47 countries. Since then, the outbreak has continued to grow, and there are now more than 16,000 reported cases from 75 countries and territories, and five deaths.
00:05:29

In light of the evolving outbreak, I reconvened the committee on Thursday of this week to review the latest data and advise me accordingly. I thank the committee for its careful consideration of the evidence and issues. On this occasion, the committee was unable to reach a consensus on whether the outbreak represents a public health emergency of international concern. The reasons the committee members gave for and against are laid out in the report we are publishing today.

Under the International Health Regulations, I am required to consider five elements in deciding whether an outbreak constitutes a public health emergency of international concern. First, the information provided by countries, which in this case shows that this virus has spread rapidly to many countries that have not seen it before. Second, the three criteria for declaring a public health emergency of international concern under the International Health Regulations, which have been met.

Third, the advice of the Emergency Committee, which has not reached a consensus. Fourth, scientific principles, evidence and other relevant information, which are currently insufficient and leave us with many unknowns. And fifth, the risk to human health, international spread, and the potential for interference with international traffic.

WHO’s assessment is that the risk of monkeypox is moderate globally and in all regions, except in the European region, where we assess the risk is high. There is also a clear risk of further international spread, although the risk of interference with international traffic remains low for the moment.
00:07:42

So in short, we have an outbreak that has spread around the world rapidly, through new modes of transmission, about which we understand too little and which meets the criteria in the International Health Regulations. For all of these reasons, I have decided that the global monkeypox outbreak represents a public health emergency of international concern.

Accordingly, I have made a set of recommendations for four groups of countries. First, those that have not yet reported a case of monkeypox or have not reported a case for more than 21 days. Second, those with recently imported cases of monkeypox and that are experiencing human-to-human transmission.

This includes recommendations to implement a coordinated response to stop transmission and protect vulnerable groups. To engage and protect affected communities, to intensify surveillance and public health measures, to strengthen clinical management and infection prevention and control in hospitals and clinics, to accelerate research into the use of vaccines, therapeutics and other tools, and recommendations on international travel.

The third group of countries is those with transmission of monkeypox between animals and humans, and the fourth is countries with manufacturing capacity for diagnostics, vaccines and therapeutics.
00:09:31

My full recommendations are laid out in my statement. I thank the Emergency Committee for its deliberations and advice. I know this has not been an easy or straightforward process and that there are divergent views among the members. The International Health Regulations remains a vital tool for responding to the international spread of disease, but this process demonstrates once again that this vital tool needs to be sharpened to make it more effective.

So I’m pleased that alongside the process of negotiating a new international accord on pandemic preparedness and response, WHO’s Member States are also considering targeted amendments to the International Health Regulations, including ways to improve the process for declaring a public health emergency of international concern.

Although I am declaring a public health emergency of international concern, for the moment this is an outbreak that is concentrated among men who have sex with men, especially those with multiple sexual partners. That means that this is an outbreak that can be stopped with the right strategies in the right groups. It’s therefore essential that all countries work closely with communities of men who have sex with men to design and deliver effective information and services and to adopt measures that protect the health, human rights and dignity of affected communities.

Stigma and discrimination can be as dangerous as any virus. In addition to our recommendations to countries, I am also calling on civil society organisations, including those with experience in working with people living with HIV, to work with us on fighting stigma and discrimination. But with the tools we have right now, we can stop transmission and bring this outbreak under control. I thank you. And Christian, back to you.
00:11:56

CL Thank you very much, Dr Tedros. Let me now open the floor for questions from the media. Again, just to remind you, to get into the queue for asking questions, you need to raise your hand with the Raise Hand icon, and then please don’t forget to unmute yourself. We have a couple of questions already lined up, and we’ll start with Kai Kupferschmidt from Science. Kai, please unmute yourself.

KK Yes, thank you very much for doing this on a Saturday, and thanks for taking my question. Really briefly maybe, Tedros, could you give an idea of what you were weighing in your mind as well when you made this decision? As far as I understand, it is the first time since the IHR from 2005 that a PHEIC has been declared without the Emergency Committee recommending it. So I’d just be curious to understand a little bit your deliberations on this. And then what do you hope this changes, of course? What do you want to see now?

CL Thank you very much, Kai, and I guess we’ll start with Dr Mike Ryan.

MR Thanks, Kai. I don’t pretend to know what is in the Director-General’s mind, but in conversation, it’s quite clear from the DG’s perspective that, yes, you are correct, the DG always listens to and tries to concur with the findings of the committee.
00:13:23

And in this case, he’s not going against their advice or findings. He found that the committee did not reach a consensus despite having a very open, very useful, very considered debate on the issues. In that sense, he’s not going against the committee. What he’s recognising is that there are deep complexities in this issue, there are uncertainties on all sides, and he’s reflecting that uncertainty in his determination of the event to be a PHEIC.

And in that sense, I think, Kai, to answer the second part of your question, I believe what he hopes we can do from here is to intensify our efforts. He sees a window of opportunity to bring this disease under control. He sees that we can redouble our efforts. We can act together in science, together in solidarity in support of those affected. And as he said again and again in his statement, and you’ll find repeated in his report, that all of this must occur with absolute respect for the human rights and dignity of all those affected and all those responding.

So I think this is a call to action. This is not the first. The DG brought the committee together. It was an alert to the world. The WHO has been highly active on this since day one. This is not the beginning of the response. This is an intensification of his calls to the world that we must act now and we must act together, as we have been acting up to now. But like every effort in human science and human health, there are times when you must accelerate that effort. And I think today’s call is for an acceleration of our collective efforts to bring this disease under control.

CL Thank you very much. And we’ll go to the next question, and that goes to Apoorva Mandavilli from The New York Times. Apoorva, please unmute yourself.
00:15:16

AM Hi. Thank you for taking my question. Given this emergency that you’re declaring, can you give us an update on the efforts you’re making to get vaccines and drugs to countries that have had limited or no supply at all so far?

CL Thank you very much for that question. And for vaccine supplies, maybe I’m going to try with Tim Nguyen, who is the Unit Head for High Impact Events. And then, let me see, maybe we have a colleague online also. Let’s go ahead.

TN Thank you, Apoorva, for your question. So since the beginning of this outbreak, WHO has been in regular contact with the manufacturer of these medical countermeasures, including with Member States who previously have made national stockpiles of smallpox countermeasures available in their national stockpiles. And from these discussions, we know and have an understanding of some of the countries that have access and the global supply situation.

I think, first, when we look at the demand situation of one of the countermeasures, the MVA-BN vaccine, we know that from the countries that are reporting cases at the moment, roughly half of them have already secured access to this vaccine. For the other half, we don’t know for the moment. We have some information that some of them are in discussion with the manufacturers to procure this vaccine.
00:16:52

At the same time, WHO continues to discuss with Member States that are holding larger stockpiles for solidarity in sharing and donating vaccines to those that don’t have access at the moment. So this is an intense effort WHO is doing at the moment.

Secondly, on the supply situation, we have been discussing with those manufacturers what is available in 2022. We have a rough understanding about the three vaccines that are existing at the moment that have been mentioned in the WHO interim guidance for immunisation.

So on the MVA-BN vaccine, we do know that at the moment, 16.4 million doses exist in bulk, which means they require fill and finish. We have roughly 1 million of those already in a fill and finish situation. On the other third-generation vaccine, the LC16 in Japan, we know from the manufacturer that this is only being produced for the government of Japan. And we have good discussion with the government of Japan on how to make some of these accessible to other countries.

And thirdly, on the so-called second-generation vaccine, ACAM2000, we know that roughly 100 million doses of this vaccine exist with various Member States in their national stockpiles. So this is the supply situation in 2022. And we are evaluating with the manufacturer what will be more available in 2023, and these are ongoing discussions.

I would like to underline one thing that is very important to WHO. We do have uncertainties around the effectiveness of these vaccines because they haven’t been used in this context and at this scale before.
00:18:44

And therefore, we are calling on and working with our Member States, that when these vaccines are being delivered, that they are delivered in the context of clinical trial studies, and prospectively collecting this data to increase our understanding on the effectiveness of these vaccines. Thank you.

CL Thank you very much. And we’ll go to Dr Rogério Gaspar, Director of Regulation and Prequalification. Rogério, please.

RG Thank you. Thank you so much. I’ll be very quick after what Tim just said, because it’s very exhaustive. Three main points. One is the fact that WHO, together with many regulators in the world, has been coordinating with the R&D Blueprint team inside WHO, preparing for this. So there’s a lot of work that was already in terms of preparation for a scenario like this.

Second one is that we’ll continue to deliver the necessary services to support regulatory systems worldwide. And we are seeing two types of countries, countries that have strong regulatory systems with an evolving situation in terms of the regulatory approval, as we have seen yesterday from the European Medicines Agency, and we have also a responsibility to support Member States that are not in the same situation. We have been preparing for this. The preparation for the support is finalised. So as we have done through COVID-19, we are in a situation to move forward.
00:20:11

The third point is that, of course, having the distribution of vaccines and also therapeutics, because therapeutics is also an important part of this, in terms of the deployment and the monitoring of any eventual safety signals under a context in which part of this context, as the DG just referred, will be to foster the research on this area, with lessons learned from COVID-19 and other vaccines and use of other vaccines, we developed already an app that is ready and tested and prepared to reinforce global pharmacovigilance systems in the deployment of any measures needed, including vaccines and therapeutics. Over from my side.

CL Thank you very much, both. With this, we have one more from Dr Mike Ryan, please.

MR Again, in terms of vaccine policy, WHO SAGE have looked at the policies for using this vaccine, and certainly the use of this vaccine is primarily and classically associated with the vaccination of contacts of cases, which is assuming some post-exposure element to the vaccination. There then is the possibility of vaccinating people in advance of being exposed, which is vaccinating an at-risk group.

And in that sense, when we talk about trying to use this vaccine as a measure to stop this outbreak or to control this outbreak, we really want to see these vaccines used in that context, in the context of those most at risk, to protect those most at risk. Those most at risk are those who are currently in contact with the virus or those likely to be exposed to that virus. So in terms of prioritisation here, we need to look at the equity and solidarity issues not purely in a geographic context, but we need to look at these in terms of the people who are most likely to suffer exposure to this disease.
00:22:08

Secondly, it’s important to remember that when this vaccine is given in a pre-exposure context, it is not like giving an antiviral. It takes time for vaccines to work. And in this case, it can take up to three weeks, I believe, for this vaccine to take full effect. So being vaccinated does not give you instant protection. The best way to avoid this infection is to avoid being exposed to it, and if you are exposed to it, to avoid being the person that transmits that further to somebody else.

So breaking the chains of transmission are about preventing onward transmission. That has both a behavioural element but it also has a very strong additional element, that if vaccines are used properly, judiciously and in the right people, vaccines can be very effective at preventing onward transmission of this virus.