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  • UK PM listened to his scientists about Covid-19, but they were slow to sound the alarm

    UK PM listened to his scientists about Covid-19, but they were slow to sound the alarm

    UK PM listened to his scientists about Covid-19, but they were slow to sound the alarm 1

    LONDON: It was early spring when British scientists laid out the bald truth to their government. It was “highly likely,“ they said, that there was now “sustained transmission” of COVID-19 in the United Kingdom.

    If unconstrained and if the virus behaved as in China, up to four-fifths of Britons could be infected and one in a hundred might die, wrote the scientists, members of an official committee set up to model the spread of pandemic flu, on March 2. Their assessment didn’t spell it out, but that was a prediction of over 500,000 deaths in this nation of nearly 70 million.

    Yet the next day, March 3, Prime Minister Boris Johnson was his cheery self. He joked that he was still shaking hands with everyone, including at a hospital treating coronavirus patients.

    “Our country remains extremely well prepared,“ Johnson said as Italy reached 79 deaths. “We already have a fantastic NHS,“ the national public health service, “fantastic testing systems and fantastic surveillance of the spread of disease.”

    Alongside him at the Downing Street press conference was Chris Whitty, the government’s chief medical adviser and himself an epidemiologist. Whitty passed on the modelling committee’s broad conclusions, including the prediction of a possible 80% infection rate and the consequent deaths. But he played them down, saying the number of people who would be infected was probably “a lot lower” and coming up with a total was “largely speculative.”

    The upbeat tone of that briefing stood in sharp contrast with the growing unease of many of the government’s scientific advisers behind the scenes. They were already convinced that Britain was on the brink of a disastrous outbreak, a Reuters investigation has found.

    Interviews with more than 20 British scientists, key officials and senior sources in Johnson’s Conservative Party, and a study of minutes of advisory committee meetings and public testimony and documents, show how these scientific advisers concluded early the virus could be devastating.

    But the interviews and documents also reveal that for more than two months, the scientists whose advice guided Downing Street did not clearly signal their worsening fears to the public or the government. Until March 12, the risk level, set by the government’s top medical advisers on the recommendation of the scientists, remained at “moderate,“ suggesting only the possibility of a wider outbreak.

    “You know, there’s a small little cadre of people in the middle, who absolutely did realise what was going on, and likely to happen,“ said John Edmunds, a professor of infectious disease modelling and a key adviser to the government, known for his work on tracking Ebola. Edmunds was among those who did call on the government to elevate the warning level earlier.

    From the outset, said Edmunds, work by scientists had shown that, with only limited interventions, the virus would trigger an “overwhelming epidemic” in which Britain’s health service was not going “to get anywhere near being able to cope with it. That was clear from the beginning.”

    But he said: “I do think there’s a bit of a worry in terms you don’t want to unnecessarily panic people.”

    Johnson, who himself has sickened with the virus, moved more slowly than the leaders of many other prosperous countries to adopt a lockdown. He has been criticised for not moving more swiftly to organise mass tests and mobilise supplies of life-saving equipment and beds. Johnson was hospitalized on April 5 and moved to intensive care the next day.

    It is too soon to judge the ultimate soundness of the UK’s early response. If history concludes that it was lacking, then the criticism levelled at the prime minister may be that, rather than ignoring the advice of his scientific advisers, he failed to question their assumptions.

    Interviews and records published so far suggest that the scientific committees that advised Johnson didn’t study, until mid-March, the option of the kind of stringent lockdown adopted early on in China, where the disease arose in December, and then followed by much of Europe and finally by Britain itself. The scientists’ reasoning: Britons, many of them assumed, simply wouldn’t accept such restrictions.

    The UK scientists were also mostly convinced – and many still are – that, once the new virus escaped China, quarantine measures would likely not succeed. Minutes of technical committees reviewed by Reuters indicate that almost no attention was paid to preparing a programme of mass testing. Other minutes and interviews show Britain was following closely a well-laid plan to fight a flu pandemic – not this deadlier disease. The scientists involved, however, deny that the flu focus ultimately made much difference.

    Now, as countries debate how to combat the virus, some experts here say, the lesson from the British experience may be that governments and scientists worldwide must increase the transparency of their planning so that their thinking and assumptions are open to challenge.

    John Ashton, a clinician and former regional director of Public Health England, the government agency overseeing healthcare, said the government’s advisers took too narrow a view and hewed to limited assumptions. They were too “narrowly drawn as scientists from a few institutions,“ he said. Their handling of COVID-19, Ashton said, shows the need for a broader approach. “In the future we need a much wider group of independent advisers.”

    Michael Cates, who succeeded Stephen Hawking as Lucasian Professor of Mathematics at Cambridge University, is leading an initiative by the Royal Society, the UK’s leading scientific body, to bring modellers in from other scientific disciplines to help understand the epidemic.

    “Without faulting anyone so far, it’s vital, where there is such a lot at stake, to throw the maximum possible light on the methods, assumptions and data built into our understanding of how this epidemic will develop,“ he told Reuters.

    In a statement to Reuters, a spokesperson for the Department of Health and Social Care said the government was delivering “a science-led action plan” to contain the outbreak. “As the public would expect, we regularly test our pandemic plans and what we learned from previous exercises has helped us to rapidly respond to COVID-19.”

    A LOW RISK TO THE PUBLIC

    When news came from China in January of a new infectious disease, Johnson had reason to believe his country was well prepared. It had some of the world’s best scientists and a well-drilled plan to deal with potentially lethal pandemics. Perhaps, some scientists say in hindsight, the plan made them slow to adapt.

    For many years, the Cabinet Office – a collection of officials who act as the prime minister’s direct arm to run the government – took the threat of pandemics seriously. Presciently, it rated pandemics as the Number 1 threat to the country, ahead of terrorism and financial crashes.

    At the centre of planning was a small group of scientists, among them Edmunds. His research group at the London School of Hygiene and Tropical Medicine runs one of the two computer modelling centres for epidemics that have mostly driven government policy. The other is at nearby Imperial College. Edmunds remembers that early in the outbreak, the data from China were sketchy, in the period “where the Chinese were trying to pretend that this wasn’t transmissible between humans.”

    Edmunds and his colleague at Imperial, Neil Ferguson, were part of an alphabet soup of committees that fed advice into the Cabinet Office machinery around the prime minister. Both were founders of the flu pandemic modelling committee, known as SPI-M, that produced the March 2 report warning of more than 500,000 deaths. This committee had met together for nearly 15 years.

    Ferguson did not respond to a request to be interviewed for this article.

    Edmunds and Ferguson were also part of NERVTAG, the New and Emerging Respiratory Virus Threats Advisory Group. Both too were members of the Scientific Advisory Group for Emergencies, known as SAGE, that advises the government in times of crisis. SAGE reports directly to Johnson and the government’s main emergency committee, COBRA.

    At first, when NERVTAG met on January 13, it studied information from China that there was “no evidence of significant human to human transmission” of the new virus, according to minutes of the meeting. The scientists agreed the risk to the UK population was “very low.”

    The evidence soon changed, but this wasn’t reflected in the official threat level. By the end of January, scientists in China began releasing clinical data. Case studies published in the British medical journal, The Lancet, showed 17% of the first 99 coronavirus cases needed critical care. Eleven patients died. Another Chinese study, in the same magazine, warned starkly of a global spread and urged: “Preparedness plans and mitigation interventions should be readied for quick deployment globally.”

    Edmunds recalled that “from about mid January onwards, it was absolutely obvious that this was serious, very serious.” Graham Medley, a professor of infectious diseases modelling at the London School and chairman of SPI-M, agreed. He said that the committee was “clear that this was going to be big from the first meeting.” At the end of January, his committee moved into “wartime” mode, he said, reporting directly into SAGE.

    Dr Jon Read, a senior lecturer in biostatistics at the University of Lancaster, also a member of SPI-M, said by the end of January it was apparent the virus had “pandemic potential” and that death rates for the elderly were brutal. “From my perspective within the sort of modelling community, everybody’s aware of this, and we’re saying that this is probably going to be pretty bad,“ he said.

    But the scientists did not articulate their fears forcefully to the government, minutes of committee meetings reveal.

    On January 21, scientists on NERVTAG endorsed the elevation of the UK risk warning from COVID-19 from “very low” to “low.” SAGE met formally for the first time the following day about the coronavirus threat. So did COBRA, which was chaired by Matt Hancock, the health secretary, who would contract the virus himself in late March. He told reporters after the meeting: “The clinical advice is that the risk to the public remains low.”

    In response to questions from Reuters, the government’s Department of Health declined to clarify how the risk levels are defined or what action, if any, they trigger. In a statement, a spokesperson said: “Increasing the risk level in the UK is a belt and braces measure which allows the government to plan for all future eventualities.”

    Two days later, China put the city of Wuhan, where the outbreak began, into a complete lockdown. Hubei, the surrounding province, would follow. But already, 17 passenger flights had flown directly from Wuhan to Britain since the start of 2020, and 614 flights from the whole of China, according to FlightRadar24, a flight-tracking service. That meant thousands of Chinese, some of them potential carriers, had come to Britain. On April 5, scientific adviser Ferguson said he estimated only one-third of infected people reaching Britain had been detected.

    As they watched China impose its lockdown, the British scientists assumed that such drastic actions would never be acceptable in a democracy like the UK. Among those modelling the outbreak, such stringent counter-measures were not, at first, examined.

    “We had milder interventions in place,“ said Edmunds, because no one thought it would be acceptable politically “to shut the country down.” He added: “We didn’t model it because it didn’t seem to be on the agenda. And Imperial (College) didn’t look at it either.” The NERVTAG committee agreed, noting in its minutes that tough measures in the short term would be pointless, as they “would only delay the UK outbreak, not prevent it.”

    That limited approach mirrored the UK’s longstanding pandemic flu strategy. The Department of Health declined a request from Reuters for a copy of its updated pandemic plan, without providing a reason. But a copy of the 2011 “UK Influenza Pandemic Preparedness Strategy 2011,“ which a spokesman said was still relevant, stated the “working presumption will be that Government will not impose any such restrictions. The emphasis will instead be on encouraging all those who have symptoms to follow the advice to stay at home and avoid spreading their illness.”

    According to one senior Conservative Party politician, who was officially briefed as the crisis unfolded, the close involvement in the response to the coronavirus of the same scientific advisers and civil servants who drew up the flu plan may have created a “cognitive bias.”

    “We had in our minds that COVID-19 was a nasty flu and needed to be treated as such,“ he said. “The implication was it was a disease that could not be stopped and that it was ultimately not that deadly.”

    While the UK was prepared to fight the flu, places in Asia like China, Hong Kong, Singapore and South Korea had built their pandemic plans with lessons learned from fighting the more lethal SARS outbreak that began in 2002, he said. SARS had a fatality rate of up to 14%. As a result, these countries, he said, were more ready to resort to widespread testing, lockdowns and other draconian measures to keep their citizens from spreading the virus.

    Scientists involved in the UK response disagree that following the government’s flu plan clouded their thinking or influenced the outbreak’s course. The plan had a “reasonable worst case” scenario as devastating as the worst predictions for COVID-19, they note.

    Mark Woolhouse, a professor of infectious diseases epidemiology at the University of Edinburgh, and a member of the SPI-M committee, said COVID-19 did behave differently than an expected pandemic flu – for example school closures proved to be far less effective in slowing the spread of the coronavirus. But, broadly, “the government has been consistently responsive to changing facts.”

    By the end of January, the government’s chief medical adviser, Whitty, was explaining to politicians in private, according to at least two people who spoke to him, that if the virus escaped China, it would in time infect the great majority of people in Britain. It could only be slowed down, not stopped. On Jan 30, the government raised the threat level to “moderate” from “low.”

    The country’s medical officers “consider it prudent for our governments to escalate planning and preparation in case of a more widespread outbreak,“ a statement said at the time. Whitty did not respond to questions from Reuters for this article.

    A TIME TO PREPARE

    On the evening of January 31, Boris Johnson sat before a fireplace in 10 Downing Street and told the nation, in a televised address: “This is the moment when the dawn breaks and the curtain goes up on a new act in our great national drama.”

    He was talking of finally delivering Brexit, or what he called “this recaptured sovereignty.” Until that moment, Johnson’s premiership had been utterly absorbed by delivering on that challenge.

    With Brexit done, Johnson had the chance to focus on other matters the following month, among them the emerging virus threat. But leaving the European Union had a consequence.

    Between February 13 and March 30, Britain missed a total of eight conference calls or meetings about the coronavirus between EU heads of state or health ministers – meetings that Britain was still entitled to join. Although Britain did later make an arrangement to attend lower-level meetings of officials, it had missed a deadline to participate in a common purchase scheme for ventilators, to which it was invited. Ventilators, vitally important to treating the direst cases of COVID-19, have fallen into short supply globally. Johnson’s spokesman blamed an administrative error.

    A Downing Street aide told Reuters that from around the end of January, Johnson concentrated his attention increasingly on the coronavirus threat, receiving “very frequent” updates at least once per day from mid February, either in person or via a daily dashboard of cases.

    In the medical and scientific world, there was growing concern about the threat of the virus to the UK. A report from Exeter University, published on February 12, warned a UK outbreak could peak within four months and, without mitigation, infect 45 million people.

    That worried Rahuldeb Sarkar, a consultant physician in respiratory medicine and critical care in the county of Kent, who foresaw that intensive care beds could be swamped. Even if disease transmission was reduced by half, he wrote in a report aimed at clinicians and actuaries in mid-February, a coronavirus outbreak in the UK would “have a chance of overwhelming the system.”

    With Whitty stating in a BBC interview on February 13 that a UK outbreak was still an “if, not a when,“ Richard Horton, a medical doctor and editor of the Lancet, said the government and public health service wasted an opportunity that month to prepare quarantine restriction measures and a programme of mass tests, and procure resources like ventilators and personal protective equipment for expanded intensive care.

    Calling the lost chance a “national scandal” in a later editorial, he would testify to parliament about a mismatch between “the urgent warning that was coming from the frontline in China” and the “somewhat pedestrian evaluation” of the threat from the scientific advice to the government.

    After developing a test for the new virus by January 10, health officials adopted a centralised approach to its deployment, initially assigning a single public laboratory in north London to perform the tests. But, according to later government statements, there was no wider plan envisaged to make use of hundreds of laboratories across the country, both public and private, that could have been recruited.

    According to emails and more than a dozen scientists interviewed by Reuters, the government issued no requests to labs for assistance with staff or testing equipment until the middle of March, when many abruptly received requests to hand over nucleic acid extraction instruments, used in testing. An executive at the Weatherall Institute of Molecular Medicine at the University of Oxford said he could have carried out up to 1,000 tests per day from February. But the call never came.

    “You would have thought that they would be bashing down the door,“ said the executive, who spoke on condition of anonymity. By April 5, Britain had carried out 195,524 tests, in contrast to at least 918,000 completed a week earlier in Germany.

    Nor was there an effective effort to expand the supply of ventilators. The Department of Health told Reuters in a statement that the government started talking to manufacturers of ventilators about procuring extra supplies in February. But it was not until March 16, after it was clear supplies could run out, that Johnson launched an appeal to industry to help ramp up production.

    Charles Bellm, managing director of Intersurgical, a global supplier of medical ventilation products based outside London, said he has been contacted by more than a dozen governments around the world, including France, New Zealand and Indonesia. But there had been no contact from the British government. “I find it somewhat surprising, I have spoken to a lot of other governments,“ he said.

    Countering such criticism, Hancock, the health minister, said the government is on track to deliver about 10,000 more ventilators in the coming weeks. One reason Britain was behind some countries on testing, he said, was the absence of a large diagnostics industry at the outbreak of the epidemic. “We didn’t have the scale.”

    GAME OVER

    It was during the school half-term holidays in February that frontline doctor Nicky Longley began to realise that early efforts to contain the disease were likely doomed.

    For weeks now, doctors and public health workers had been watching out for people with flu-like symptoms coming in from China. Longley, an infectious diseases consultant at London’s Hospital for Tropical Diseases, was part of a team that staffed a public health service helpline for those with symptoms. The plan, she said, had been to make all effort to catch every case and their contacts. And “to start with, it looked like it was working.”

    But then, bad news. First, on Wednesday the 19th of February, came the shock news from Iran of two deaths. Then, on Friday the 21st, came a death in Italy and a bloom of cases in Lombardy and Veneto regions. Britain has close links to both countries. Thousands of Britons were holidaying in Italy that week.

    “I don’t think anybody really foresaw what was happening in Italy,“ Longley said. “And I think, the minute everybody saw that, we thought: ‘This is game over now.’”

    Until then, Longley said, everyone felt “there was a chance to stamp it out” even though most were sceptical it could be done long-term. But after Iran and Italy, it was obvious containment would not work. The contact tracing continued for a while. But as the cases in London built up, and the volume of calls to the helpline mushroomed, the priority began to shift to clinical care of the serious cases. “At a certain point you have to make a decision about where you put your efforts as a workforce.”

    Edmunds noted that Iran and Italy had hardly reported a case until that point. “And then, all of sudden you had deaths recorded.” There was a rule of thumb that, in an outbreak’s early stages, for each death there were probably 1,000 cases in a community. “And so it was quite clear that there were at least thousands of cases in Italy, possibly tens of thousands of cases in Italy right then.”

    Amid the dreadful news from Italy, the scientists at NERVTAG convened by phone that Friday, 21st February. But they decided to recommend keeping the threat level at “moderate,“ where it had sat since January 30th. The minutes don’t give a detailed explanation of the decision. Edmunds, who had technical difficulties and couldn’t be heard on the call, emailed afterwards to ask the warning to be elevated to “high,“ the minutes revealed. But the warning level remained lower. It’s unclear why.

    “I just thought, are we still, we still thinking that it’s mild or something? It definitely isn’t, you know,“ said Edmunds.

    A spokesman for the government’s chief scientific adviser, Sir Patrick Vallance, didn’t directly respond to Reuters questions about the threat level. Asked whether, with hindsight, the scientists’ approach was the right one, the spokesperson said in a statement that “SAGE and advisers provide advice, while Ministers and the Government make decisions.”

    HERD IMMUNITY

    On Sunday, March 1st, Ferguson, Edmunds and other advisers spent the day with NHS public health service experts trying to work out how many hospital beds and other key resources would be needed as the outbreak exploded. By now, Italian data was showing that a tenth of all infected patients needed intensive care.

    The following day, pandemic modelling committee SPI-M produced its “consensus report” that warned the coronavirus was now transmitting freely in the UK. That Thursday, March 5, the first death in the UK was announced. Italy, which reached 827 deaths by March 11, ordered a national lockdown. Spain and France prepared to follow suit.

    Johnson held out against stringent measures, saying he was following the advice of the government’s scientists. He asserted on March 9: “We are doing everything we can to combat this outbreak, based on the very latest scientific and medical advice.”

    Indeed, the government’s Scientific Advisory Group for Emergencies, SAGE, had recommended that day, with no dissension recorded in its summary, that the UK reject a China-style lockdown. SAGE decided that “implementing a subset of measures would be ideal,“ according to a record of its conclusions. Tougher measures could create a “large second epidemic wave once the measures were lifted,“ SAGE said.

    On March 12 came a bombshell for the British public. Chris Whitty, the chief medical officer, announced Britain had moved the threat to UK citizens from “moderate” to “high.” And he said the country had moved from trying to contain the disease to trying to slow its spread. New cases were not going to be tracked at all. “It is no longer necessary for us to identify every case,“ he said. Only hospital cases would, in future, be tested for the virus. What had been an undisclosed policy was in the open: beyond a certain point, attempts to completely extinguish the virus would stop.

    The same day, putting aside his jokey self, Johnson made a speech in Downing Street, flanked by two Union Jacks and evoking the spirit of Winston Churchill’s “darkest hour” address. He warned: “I must level with you, level with the British public – more families, many more families are going to lose loved ones before their time.”

    For most Britons, it came as a shock. Several of the next day’s newspapers splashed Johnson’s words on their front pages.

    Vallance, the government’s chief scientific adviser, who chaired SAGE, said in a BBC interview on March 13 that the plan was to simply control the pace of infection. The government had, for now, rejected what he called “eye-catching measures” like stopping mass gatherings such as football games or closing schools. The “aim is to try and reduce the peak, broaden the peak, not to suppress it completely.” Most people would get the virus mildly, and this would build up “herd immunity” which, in time, would stop the disease’s progress.

    But by now, the country was rebelling. Major institutions decided to close. After players began to get infected, the professional football leagues suspended their games. As Johnson still refused to close schools and ban mass gatherings, the Daily Mirror’s banner headline, summing up a widespread feeling, asked on March 13: “Is It Enough?”

    The catalyst for a policy reversal came on March 16 with the publication of a report by Neil Ferguson’s Imperial College team. It predicted that, unconstrained, the virus could kill 510,000 people. Even the government’s “mitigation” approach could lead to 250,000 deaths and intensive care units being overwhelmed at least eight times over.

    Imperial’s prediction of over half a million deaths was no different from the report by the government’s own pandemic modelling committee two weeks earlier. Yet it helped trigger a policy turn-around, both in London and in Washington, culminating seven days later in Johnson announcing a full lockdown of Britain. The report also jarred the U.S. administration into tougher measures to slow the virus’ spread.

    Ferguson was now in isolation himself after catching the virus. Testifying by video link to a committee in Parliament, he explained why he and other scientific advisers had shifted from advocating partial social-distancing measures to warning that without a rigorous shutdown, the NHS would be overwhelmed. The reason, he said, lay in data coming out of Italy that showed large numbers of patients required critical care.

    “The revision was that, basically, estimates of the proportion of patients requiring invasive ventilation, mechanical ventilation, which is only done in a critical care unit, roughly doubled,“ he said.

    Edmunds had a different explanation for the policy shift.

    What allowed Britain to alter course, said Edmunds, was a lockdown in Italy that “opened up the policy space” coupled with new data. First came a paper by Edmunds’ own London School team that examined intermittent lockdowns, sent to the modelling committee on March 11 and validated by Edinburgh University. Ferguson’s revised Imperial research followed.

    Woolhouse, the Edinburgh professor, confirmed the sequence.

    Edmunds said these new studies together had demonstrated that if the British government imposed a lengthy period of tougher measures, perhaps relaxed periodically, then the size of the epidemic could be substantially reduced.

    Still, without a vaccine or effective treatments, it’s going to be hard to avoid a substantial part of the British population getting infected, said Edmunds. “Until you get to a vaccine, there is no way of getting out of this without certainly tens of thousands of deaths,“ he said. “And probably more than that.”

    Now subject to intense public scrutiny, the modelling teams at universities across Britain continue to work on different scenarios for how the world can escape the virus’s clutches. According to Medley, the chairman of the SPI-M pandemic modelling committee, no one now doubts, for all the initial reservations, that a lockdown was essential in Britain.

    Medley added: “At the moment we don’t know what’s going to happen in six months. All we know is that unless we stop transmission now, the health service will collapse. Yep, that’s the only thing we know for sure.” – Reuters

    UK PM listened to his scientists about Covid-19, but they were slow to sound the alarm
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  • Virtual Press Conference on COVID-19- 06 April 2020

    Virtual Press Conference on COVID-19- 06 April 2020

    Originally broadcast live on 06 April 2020, the daily press briefing on coronavirus COVID-19, direct from WHO Headquarters, Geneva Switzerland with Dr Tedros WHO Director-General, Dr Micheal Ryan, Executive Director of the Health Emergencies Programme, and Dr Maria Van Kerkhove, Technical lead, WHO Health Emergencies Programme with special guests Lady Gaga and Hugh Evans, CEO and Co-founder of Global Citizen.

    Transcript:

    Speaker key:

    TJ        Tarik Jasarevic

    TAG    Dr Tedros Adhanom Ghebreyesus

    LG       Lady Gaga

    HE       Hugh Evans

    MR      Dr Michael Ryan JA  Jamie

    MK      Dr Maria Van Kerkhove KA Kai

    KT       Kate

    IN        Innocent

    YA      Yang

    00:00:19

     

    TJ        Good evening to everyone from Geneva and WHO headquarters. Welcome to the regular press conference on COVID-19. Journalists who are online can ask their questions by clicking  raise hand if  you are
    on Zoom.  Today we have a special guest but  I will  let Dr Tedros do his opening remarks and introduce them.  Before I give  the floor  to Dr Tedros, just to remind you, we will also be sending you some news from other
    WHO offices around the world with the audio file  from this  press briefing a little  bit  later. I give  the floor  immediately to Dr Tedros.

     

    00:01:07

     

    TAG    Good morning, good  afternoon and good  evening.  The COVID-19 pandemic continues to take a heavy toll on families, communities and nations the world over but it’s also giving rise to incredible acts of generosity,
    solidarity and co-operation. We have said consistently that we’re all in this together and we can only succeed together. We need an all- of-society approach with everyone playing their part. That includes  people  in  the entertainment
    industry.

     

    Today I’m very delighted to be joined by one of the biggest names in entertainment in the world, Lady Gaga, and my friend Hugh Evans, the founder and CEO of Global Citizen.

    WHO has been working with Global Citizen for several weeks on the Together At Home concert series with artists like Chris Martin and John Legend giving free online performances.

    Now we’re working with Lady Gaga and Global Citizen to take this concept and make it even bigger through the  One World  Together  At Home virtual  global  special on Saturday 18th April. It’s now my great pleasure to invite
    Lady Gaga and Hugh Evans to say more about this very special event, One World.

    00:03:10

     

    LG       Thank you very much, Dr Tedros. Good morning, good afternoon  and good  evening to everyone who’s listening and watching. I would  like  to thank the World  Health Organization and the
    United Nations as well as Global Citizen; thank you very much, Dr Tedros and Hugh Evans, for all of your leadership in this fight against COVID-19 and thank you very much to the World Health Organization  for asking  me to collaborate 
    with  you on this special.

    We are also very grateful to all of the healthcare professionals across the country and around the world who are on the front lines during COVID-19. This  global  pandemic  is  a catastrophe. I’m so thankful to them and I’m also
    praying for those who are sick. It’s been a pleasure to partner with Global Citizen  and we’ve been working  all together  behind  the scenes to raise money for the World Health Organization.

    I would also like to send my prayers as well to people  that are losing  their  jobs  and are having a hard time feeding themselves  and their  children.  We are raising  money  for  the World Health
    Organization’s COVID-19 Solidarity  Response  Fund and seven days ago we held a  call with more than 68 corporate leaders from some of the world’s biggest and most generous companies and I asked them to join my corporate kindness
    list as there have been many corporations and philanthropists that have been very, very generous during this time.

    00:04:38

     

    Since then we have also been calling on philanthropists around the world as well and tech companies included. I’d like  to reiterate our deep gratitude  to the medical  community.  My heart is very, very aching and warm for those
    who are ER doctors as well as nurses who are sleeping in cars to make sure they don’t infect their families  or  their  patients.  What you’re doing is putting  yourselves  in  harm’s way to help the world 
    and we all salute  you and you are a triumph truly.

    I am proud to say that over the past seven days we’ve raised a total of $35 million for the Solidarity Fund. This money will [inaudible]  essential PPE, supplies  and testing kits around  the world and will help improve lab capacity
    to rapidly process tests. It will also [inaudible] research development. It is so important to think globally and to support the World Health Organization to curb the pandemic and prevent future outbreaks.

    I know Dr Tedros is particularly concerned about Africa and [inaudible]. We also need to act globally by supporting local charities  and initiatives so that the front-line health  workers in most immediate need have the resources they need
    to survive during this time. It has been an honour to help with this huge broadcast event, which will take place on April 18th, where we need to tell the stories of and celebrate the front-line community, healthcare workers and their acts of kindness.

    We will be on different networks, many networks actually and I want to [inaudible] about what we’re going to be doing. What’s very important is that two things happen for all of us; that we celebrate and we highlight the singular, kind global community
    that is arising right now. Two, we want to highlight the gravity of this historically unprecedented cultural movement and, three, we want to celebrate and encourage the power of the human spirit.

    00:06:47

    I would like to, on behalf of  the World  Health Organization  and Global  Citizen,  thank Dr Tedros as well as everyone that has donated so far. We are going to continue fundraising but I would like to also let you know that
    this broadcast special is not actually a fundraiser. We all wanted to raise the money before we went on air so when we do  air  live  on  April  18th  put your wallets away, put your credit  cards away, anything 
    away that you need to and just  sit back and enjoy the show that you all very much deserve.

    I’d like to pass this now to Hugh Evans, who’s been a wonderful partner of mine. Hugh, thank you so much and thank you, Dr Tedros.

    HE       Good morning, good afternoon,  good  evening  and thank you,  Dr Tedros  and thank you, Lady Gaga. Your Excellencies,  ladies  and gentlemen;  Lady Gaga, Dr Tedros, 
    you’ve both demonstrated extraordinary leadership at an unprecedented moment when our society is being challenged like never before and we are so thankful for your leadership. I’d like to echo Lady Gaga’s sentiment and commend the incredible acts
    of bravery demonstrated by the front-line community  health  workers around the world  and I hope  that we as a shared humanity emerge from this moment forever grateful for the work of doctors, nurses, teachers, grocery store workers and all of those who are
    the backbone of our communities.

    Global health is at the very core of the global citizen mission and we must  ensure that the world’s poorest and most  marginalised  people  have  access to resources to cope with and tackle this health crisis. Through One
    World:  Together At Home on April 18th  we’ll be calling on philanthropists, corporations and governments to fund critical global COVID-19 response efforts including distribution of resources and PPE to critical front-line healthcare
    workers.

    00:09:09

    In our partnership with the WHO and United Nations Global Citizen is committed to driving action to help ensure our global health systems are strong enough to stop a future pandemic before it happens. April 18th is going to be a moment of global unity
    connecting the world through a historic global broadcast. We are bringing together the greatest artists in the world under the passionate and extremely talented curation of Lady Gaga.

    In alphabetical order some of the artists we’ll be announcing today include Alanis Morissette, Andrea Bocelli,  Billie  Eilish,  Billy  Joe Armstrong  of Green Day, Burna Boy, Chris Martin, Sir David Beckham, Eddie Vedder,
    Sir Elton John, Finneas, Idris and Sabrina Elba, J Balvin, John Legend, Kacey Musgraves, Keith Urban, Kerry Washington,  Lang Lang,  Lizzo, Maluma, Sir Paul McCartney, Priyanka Chopra Jonas, Shah Rukh Khan, Stevie Wonder and many more to be announced over the coming weeks from all corners of the globe under the passionate and extremely talented curation of Lady Gaga.

    We’re grateful to all of you for participating and supporting this critical effort. One World Together At Home will be broadcast live on Saturday April 18th 2020 at 5:00pm PDT, 8:00pm EDT and 12:00am BST, airing on ABC, NBC, Viacom and CBS networks,
    IHeartMedia, and Bell media networks and platforms in Canada. Internationally BBC1 will run the programme on Sunday April 19th and additional  international  broadcasters include BN Media Group, Multi-Choice Group and RTE in Ireland.

    00:11:43

    The digital broadcast will celebrate and support brave community  health workers who are doing life-saving work on the front line and we’ve all seen the limitations of world leaders around this world to step up and face this extraordinary challenge 
    and we want to do our best to support the essential work of the World Health Organization, driving action and raising critical funds. Thank you again, Dr Tedros, and thank you, Lady Gaga, for your leadership.

    Thank you all.

    TJ        Thank you very much to our guests for their remarks. Dr Tedros, I guess you would like to thank them too.

    TAG    Once again I would like  to thank Lady Gaga and Hugh Evans for their  partnership. We had a call last week and I was so amazed by the energy and passion of Lady Gaga. It’s incredible commitment to humanity and that’s
    when I said, I think what she has planned can happen. It’s bringing the world together to improve awareness and to mobilise  resources to fight the pandemic so I thank her for her incredible passion and commitment  and leadership and
    also to my friend, Hugh Evans, for connecting all the dots and for his leadership.

    We all look forward to joining you for the One World: Together  At Home concert on 18th April. As the pandemic continues we recognise that individuals and governments want to do everything they can to protect themselves and others and so do we.
    We understand that some countries have recommended or are considering the use of both medical  and non-medical masks in the general population to prevent the spread of COVID-19.

    00:14:21

    First and foremost medical masks must be prioritised for health workers on the front lines  of  the response. We know medical masks can help to protect health workers but they’re in short supply globally.  We’re concerned that the mass
    use of medical  masks by the general population could exacerbate the shortage of these specialised masks for the people who need them most. In some places these shortages are putting health workers in real danger.

    In healthcare facilities WHO continues to recommend the use of medical masks, respirators and other personal protective equipment for  health workers. In the community we recommend the use of medical masks by people who are sick and those who
    are caring for a sick person at home.

    WHO has been evaluating the use of medical and non-medical masks for COVID-19 more widely. Today WHO is issuing guidance and criteria to support countries in making that decision. For example countries could consider using masks in communities where other measures such as cleaning hands and physical distancing are harder to achieve because of lack of water or cramped living conditions.

    If masks are worn they must be used safely and properly. WHO has guidance on how to put on, take off and dispose of masks. What’s clear is that there is limited research in  this  area. We encourage countries that are considering the use
    of masks for the general population to study their effectiveness so we can all learn. Most importantly masks should only  ever be used as part of a comprehensive package of interventions. There is no black or white answer and no silver bullet.
    Masks alone cannot stop the pandemic. Countries must continue to find, test, isolate and treat every case and trace every contact. Mask or no mask, there are proven things all of us can do to protect ourselves and others.

    00:17:13

    Keep your distance, clean your hands, cough or sneeze into your elbow  and avoid  touching your face. Less than 100 days since WHO was notified about the new coronavirus  research has accelerated at incredible speed. The viral genome
    was mapped  in  early January and shared globally, which enabled tests to be developed and vaccine research to start. More than 70 countries have joined WHO’s Solidarity Trial to accelerate the search for an effective treatment and about
    20 institutions and companies are racing to develop a vaccine.

    WHO is committed to ensuring that as medicines and vaccines are developed they’re shared equitably with all countries  and people.  I want to thank the  Medicines  Patent Pool and Unitaid for the initiative they announced last
    Friday to include medicines and diagnostics for COVID-19 in their licensing pool.

    I also want to thank the President of Costa Rica, President Carlos Alvadaro, and the Health Minister, Daniel Salas, for their proposal to create a pool of rights to tests, medicines and vaccines with free access or licensing on reasonable and affordable
    terms for all countries. Muchas gracias, Mr President. I support this proposal and we’re working with Costa Rica to finalise the details.

    00:19:09

    Poorer countries and fragile  economies  stand to face the biggest  shock from this  pandemic and leaving anyone unprotected will  only  prolong  the health crisis  and harm economies  more.  I call
    on all countries, companies and research institutions to support open data, open science and open collaboration so that all people can enjoy the benefits of science and research.

    Finally we’re nearing the end of the Ebola outbreak in the Democratic Republic of the Congo. This is one piece of good news. If there are no more cases the Government of the Democratic Republic of Congo could declare the outbreak over  as early
    as this  Sunday.  We’re not  there yet and we remain in full response mode. We’re continuing to investigate alerts and to test samples.

    This would not have been possible without the incredible  health workers who have put themselves at risk for more than 18 months to stop this outbreak, just as health workers are putting themselves in danger to save lives from COVID-19. Health
    workers in DRC faced the     double threat of fighting a deadly virus in one of the world’s most dangerous and unstable regions, exposing themselves to Ebola and bullets.

    Tomorrow, as you know, is WHO’s birthday, a day we celebrate each year as World Health Day. This year we’re paying tribute to the incredible contribution of all health workers, especially nurses and midwives. Nurses and midwives are the backbone of
    every health system. They’re there from the first moments of life to the last. Tomorrow we’re publishing our first report on the state of the world’s nursing which highlights gaps and makes recommendations for all countries.

    00:22:00

    One of the lessons I hope the world learns from COVID-19 is that we must invest in health workers, not only to protect lives but also to protect livelihoods. I thank you.

    TJ        Thank you very much, Dr Tedros. Also, as always, we have Dr Mike Ryan and Dr Maria Van Kerkhove, who will be answering questions. We will  now open the floor.  I will  go to one question
    that I received by email this morning and I promised to answer; that’s Ankit Kumar from India Today. Ankit is asking; we have recently seen a spike in  cases caused through religious gatherings in India, in fact almost a third of new cases
    were linked to one gathering in India. We have also seen incidents of violence against health workers due to fear and misinformation. Is WHO concerned with these developments, what is WHO’s message to religious and community leaders and their
    followers?

    MR      First and foremost the idea of violence against health workers is driven by fear and it’s driven by misunderstanding but it’s  really  unacceptable. We ask everyone and every community to see our health workers
    as our heroes and to support them in every way we can.

    With regard to gatherings of any type, be they religious or be they for other  purposes,  there are always risks associated with such gatherings in the midst of a major epidemic. WHO has issued guidance on that. Many of these gatherings
    are now postponed or cancelled.  We’ve been working very, very closely with religious  and faith-based organisations  all  over the world including  groups  from the Islamic  tradition,  Christian 
    traditions  and others and continue to work through faith-based organisations to communicate  using  our  Epiwin platform.

    00:24:21

    We’re also continuing to develop guidance specifically  for the holy  month  of Ramadan and are working through our Eastern Mediterranean regional office to be able to advise governments and religious institutions on how best to manage
    the risks associated with such holy events.

    But it’s very important again; having COVID-19 is not anybody’s fault. Every case is a victim and every case needs to be  treated with sensitivity,  as the health workers who treat them so it’s very important that we’re not profiling COVID-19
    along  racial,  along  religious,  along ethnic lines. This is not helpful.

    TJ        Thank you very much. This was a question  from Ankit  Kumar from India  Today. Now we will go to journalists online. We will start with Jamie from Associated Press. Jamie, can you hear us?

    JA        Hi, yes. Can you hear me? TJ            Yes. Please go ahead.

    JA        Great, thank you very much. I wanted to ask you about… Over the weekend Dr Anthony Fauci mentioned that – if I understood it correctly – as much as 50% of transmission could be asymptomatic. Just aligned 
    with that, if  you could  give  us a little  bit  more  about what you’re thinking about the fact that some countries have said that this outbreak is more infectious than influenza. The CDC is saying that it’s up
    to three times more infectious than influenza so what do you have to say about that? Thanks.

    00:26:13

    MK      I’ll start and then perhaps Mike or DG would like to supplement. The modes of transmission and the way in which this virus is transmitted  are of significant  interest to all of us. What we are doing is working
    with member states, we’re working with everyone that’s affected by this, looking through the research and trying to understand  when most transmission is happening, when any transmission is happening.

    What we know from reports, what we know from published literature is that the predominant way in which transmission is occurring is amongst symptomatic individuals  and these are people that can be very early on in symptoms, even when they start
    to feel a little bit unwell. This is supported by some data that attempts to catch a virus from individuals who are symptomatic.

    We also know that it’s possible that people can transmit in the few days before they become symptomatic or in their pre-symptomatic  phase. There have been some studies  that have come out and we learned about this when we were on mission
    in China back in January or early February, that there are individuals that can shed virus one to three days before they develop symptoms.

    However it’s very important to note that even if you are pre-symptomatic or even if you don’t have any recognised symptoms you still have to transmit through  droplets,  you still  have to have these infectious particles that come out
    of your nose and your mouth. So while we know that that is possible we do not believe that it’s a major driver of transmission.

    00:27:42

    We’ve also seen modelling estimates that suggest that there’re large numbers of unrecognised transmission and I used unrecognised on purpose because I’m not saying asymptomatic. I’m saying that we may be missing people who are out there who are infected
    but we’re missing them because of current surveillance strategies. That is certainly possible in many parts of the globe.

    Whether or not those individuals are asymptomatic; we will have to wait until we see the results of serologic studies, which we hope we’ll be seeing in the coming days if not weeks.

    So what we can say is that most people are transmitting this virus while they are symptomatic.

    JA        Hi, Jamie. Just in addition because I think – I would never in any way contradict my good friend, Tony Fauci, such an eminent man. There are many different estimations of what might represent asymptomatic
    transmission or other infections in the community and we do know and everyone accepts that when the seroepidemiology studies do come online we will probably find more people who’ve been infected unknowingly; there’s no question of that.

    The thing we need to address in all of this is  very often the idea of  severity versus infection and there is a huge association  between the dose  of exposure  and the severity  of infection. We see this in many other
    infectious diseases so we also probably need to look  at who is getting sick and very sick and is the dose and the type of exposure they’re getting different to those who may be exposed and seroconverted in the community.

    00:29:26

    So it’s not just a matter of looking at how many people in the community are infected but are there specific elements  of exposure  that cause individuals  to have  a higher dose of exposure or a specific route of exposure 
    that causes more severe infection?  There is  also that concept of infectious dose when we talk about the different types of transmission. If somebody is exposed to a high dose from another individual directly or from a surface that’s
    heavily contaminated you can imagine the large dose.

    In other circumstances individual particles or virus particles potentially floating through  the air; it can be demonstrated that that may happen in certain circumstances, certainly in healthcare settings. But is that significant  in 
    terms of driving  infection,  is  that significant, does that produce an infectious dose that can successfully infect another individual?

    These are all very important things that still need to be studied. Again we’re only a number of weeks into this. I think we need to have the seroepi studies. I think  we need more information on what is the infectious  dose  and particularly 
    the relationship  between the dose  of exposure or infection and the severity of disease subsequently, which has been seen with many, many other diseases in the past including cholera, Ebola and others.

    TJ        Thank you very much, Mike and Maria. We will go now to our next question; that’s Kai Kupferschmidt. Kai, can you hear us?

    00:31:01

    KA      Yes, Tarik. Thanks a lot for taking my question. I wanted to ask about the global  push  to try and find a pre-exposure  prophylaxis  or a post-exposure  prophylaxis. I understand there’re
    several trials going on, most of them with chloroquine  or hydroxychloroquine.  I was just wondering whether you can speak a little bit to what role this could potentially play.

    Of course also there’re a lot of smaller studies going on. Is there any way to make sure that they all lead to results that can be proved in the end?

    MR      Maria can give you more detail but certainly one of the Solidarity trials – I think Solidarity 3 or 4 – we have one of the trials under design which will be a multi-centre study which will look at prophylaxis in healthcare workers to see whether there’s evidence that giving lower doses of drugs like chloroquine or hydroxychloroquine to healthcare workers would reduce their risk of becoming infected in a healthcare environment.

    Those studies are certainly underway and again there are a number of those studies underway in smaller studies around the world but again as WHO we’re trying  to bring  together  a larger set of collaborative studies that will give
    us the answers we need.

    In terms of post-exposure prophylaxis I don’t believe  we have at the moment  studies  planned but Maria can speak to that but there is certainly evidence for the use of – not proven  evidence of effectiveness but there are a number
    of studies underway and trials underway that use hyperimmune globulin  in  the treatment  of disease; in  other words  they use that purified plasma of recovered individuals to give an antibody boost to people who are
    suffering the disease.

    00:32:49

    Similar approaches have been used in post-exposure prophylaxis for other diseases but Maria may be aware of studies underway in that area.

    MK      Only to add that, as you mentioned, there are a number of smaller studies that are happening globally and across a large number of countries.  We have teams through  our science division and through GOARN,
    through the Global Outbreak Alert Network, who are pulling together  available  literature  on a number  of topics,  one  of which is  looking  at different types of therapeutics and drugs.

    The idea is until we can have a study that pulls together enough of a sample size to get these answers to these questions we’re trying  to evaluate  every piece of evidence  that is  published so that we can look at the way in
    which these studies were done, we can look at the strengths, we can look at the limitations so that can help guide us closer  towards an effective treatment for COVID-19.

    TJ        Thank you very much. The next question is from BFM Radio. Is is Kate who is with us?

    KT       Yes, hi. Good evening or good morning.  I’m from BFM Radio  Malaysia. My question is, many countries around the world have imposed lock-downs or some sort of restrictions on movement. I was wondering
    what WHO’s guidance would  be; what’s the sweet spot, the kind of data that governments need to consider before lifting or relaxing  some  of these lock- downs? Thank you very much.

    00:34:29

    MR      Thank you. It is a difficulty for governments right  now  because the lock-downs  in many situations are proving effective in dampening the flames of the epidemic  in  those countries but those
    lock-downs are also causing great economic hardship and everybody especially in the developing world needs to get to a more sustainable way of managing this epidemic and controlling COVID-19 without continuing to damage economic and social life.

    The transition strategy out  of lock-down  requires  a calibrated,  step-wise approach.  It would be probably very inadvisable just to lift a complete lock-down, all of the measures because lock-downs are a general term that
    include closure of schools, closure of  churches, stay-at- home orders, closure of workplaces. It’s a mixture of different things and I think each government needs to break out, what does our lock-down actually constitute, what are the elements
    of our lock-down, where is that happening in the country, do we now understand the epidemiology of the disease in each area in which we have an element of lock-down or shut- down.

    Then to chart the path out, you have to build strong public health capacity to take over from the lock-down. In other words the lock-down is pushing the disease down by putting people back in their homes, by separating communities. Once you raise
    the lock-down you have to have an alternative method to suppress the infection. The  way to do that is active  case finding, testing, isolation of cases, tracking of contacts, quarantining of contacts and strong community education and
    participation and ownership around normal physical distancing, hygiene and giving communities the power to control infection by in effect managing their own physical distance, managing their own capacities to support the response.

    00:36:32

    In that situation, if you’ve strong public health capacity, if you’ve got a community that’s mobilised and empowered and if you’ve strengthened your health system then you’re potentially in a position to start unlocking or unwinding the lock-down.
    The specific parameters you need to be looking at are on two sides.

    One is, it would be very inadvisable to lock down [sic] if the number  of cases coming  through the hospital is already at a level where your  occupancy of  beds is  nearly at 100%.  You need to be in a position where
    you now have free beds in your system so that you’re managing and coping with the caseload and that means you have some absorption capacity left.

    You need to look at things like the doubling  rate; how  many days does it  take for the  number of cases to double? You need to look at positivity rates; what proportion of all samples that we test are positive? You’ll see in
    somewhere like Korea two to 6% of the samples  they test are positive. Last week in New York 37% of tested samples were positive so you need to carefully look at what proportion of people you test are positive.

    00:37:45

    You need to look at the number of contacts that are generated per case and it goes on and on and WHO will be issuing guidance to countries that is a much more specific around the parameters they should be looking at. There are no absolutes here, there
    are no answers, there are no numbers that say if this number is this then you do that. That doesn’t exist but what we can do is offer countries very specific  measurements  that they need to look  at to chart the path out of lock-down.

    That step-wise approach of unlocking somewhat and then waiting to see; I think you need to say, we will stop doing this element of the shut-down  and then we will  wait and we will  look at the data and if that works we go to the next
    stage and the next stage. So a careful, calibrated, step-wise exit from lock-down with putting in place public health capacities, putting in place community capacity, building the capacity of the health system to cope should the disease bounce back up; that’s the safe path out of lock-down.

    We want to achieve it as quickly as possible and we want to avoid many countries going  into that circumstance and we still have many countries around the world who are not in a locked- down situation. In fact their epidemiology would suggest
    they can avoid the worst of this and we need to support them to avoid them going into that situation.

    The most damaging lock-downs are in many developing countries  where people  – as the  DG has said many times – can live from hand to mouth, not from pay cheque to pay cheque but from day to day and we have to find adaptive solutions
    around lock-down and around disease control in vulnerable periurban populations living in poverty,  in  poor  rural communities.  We have to find alternative, adapted ways to manage lock-downs or slow-downs or shut-downs in
    those situations.

    00:39:41

    TJ        Thank you very much. This was Kate from BFM Radio in Malaysia. Now we will  go to Nigeria to Natural Star and it’s Innocent. Innocent, can you hear us?

    IN        Thank you. Can you hear me?

    TJ        Not very well but we will try. Please go ahead.

    IN        Okay, thank you for taking my questions. I have two questions to ask. One; how will WHO assess African countries on what they’ve done concerning the lock-down and management of COVID-19?

    Then the second one; there’s news going around that vaccines are to be tested on Africans when they’re developed. How true is that and is there a window that’s in the nearer future when a vaccine will be developed for COVID-19? Thank you.

    Hello?

    TJ        Yes, we are just trying to make sure that we understood the question but we will try. MR     I think this is Nigeria. Is it?

    TJ        Yes.

    00:41:08

    MR      Maria may answer the question around vaccine development. With regard to our general assessment on lock-down – and the Director-General may wish to comment on this because he’s been speaking with many leaders in Africa
    and, I believe, spoke with  the whole of the African Union leadership and countries late last week so therefore is in a much better position than me to speak about that.

    We would characterise so far, Africa’s actually doing well in this response thus far. Countries have essential capacities for testing, many countries are taking strong action and want to really focus on finding cases and doing contact tracing and trying to stop this disease becoming much more extensive given the fact that health systems are not as strong in many countries. 

    They need support in that though, they need support in testing, they need support with protective gear and they need to be given the resources to be able to mount those types of responses so I would characterise that Africa has not suffered the worst
    of this pandemic so far. The worst of it can be avoided with very, very swift action to support those countries in Africa who really do want to take a comprehensive approach to this disease.

    With the many vulnerable  people  including  refugees and migrants  who live  in  those countries it is our responsibility to provide that support but, DG, you may wish to speak about your interactions with the African
    Union countries.

    00:42:46

    MK      I’ll answer the question  around vaccines. What we can say is  that there are a number of vaccines that are in development and vaccines will be tested through clinical trials with all ethical considerations
    in place in whichever  populations  are under  study  with informed consent, with open and transparent communication. This is of the utmost importance, that not only do we have strong, robust  scientific  evidence 
    but  we ensure that all  of the studies  that are done are done with appropriate and the highest level of ethical considerations.

    One thing on the first question around Africa is that there are a number of countries in Africa right now which have very few cases and Mike has alluded to this in his earlier response.

    Some only have imported cases and there is an opportunity here, this  window  of opportunity that the DG has spoken about exists  in  many countries  still.  There is  an opportunity to prevent the worst from happening
    in a number of countries across Africa and across countries that are still seeing their first case; in some island countries.

    We need to support those governments, those countries, all of the people in those areas to prevent the worst from happening, to prevent these individual cases from becoming clusters, these clusters from becoming community transmission. I think that’s
    where we need to put  a lot of emphasis and support so that we can prevent countries  from reaching a point  where they need to put in these very restrictive movement restrictions.

    TAG    Thank you. Thank you for that question, my brother from Nigeria. On the situation, as Mike said, of course when you see the number of cases the African continent has the lowest number of cases so far but that doesn’t mean that
    the situation will not deteriorate. It may.

    00:45:06

    So Africa should do everything to prevent this situation from getting worse and that’s why African leaders are doing their best. I had a chance to participate in a meeting, a Leaders’ Coalition which was arranged or invited by the current Chairperson
    of the African Union, the President of South Africa, President Ramaphoza and many leaders from all corners of the continent have actually participated.

    The main agenda is to have a continental strategy and also make sure that that continental strategy helps the national strategy but in addition to a coalition of political leaders or the heads of state and government they have also agreed to have a coalition of business leaders. Business leaders in Africa are also getting together because Africa will need resources and one of the major problems that was identified during the discussion
    was especially shortage of equipment starting from medical equipment, PPE and test kits and so on.

    The leaders have agreed to look for concrete solutions to address the problem and they also believe that considering the number of cases we have in the continent testing cases, tracing contacts and isolating them, meaning using the comprehensive approach,
    will actually  help. They believe that lock-downs alone may not help or the physical distancing alone cannot help and they have agreed to do everything to follow the comprehensive approach.

    From WHO’s side we have been supporting and we increased, improved  the testing capacity in Africa significantly in the past two months and many countries in Africa have now testing capability although we may have a shortage of test kits but 
    we’re working  on that too and we’re finding different ways of addressing the gap.

    00:48:06

    But we will support the African Union, we will support the Africa CDC and also we will continue working through our WHO regional office in Congo Brazzaville and continue to support and fight the pandemic together.

    Then on the vaccines issue there was, I think, a comment last week from a couple of

    scientists who said the testing ground for the new vaccines will be Africa. To be honest,  I was so appalled and it was a time when I said, when we needed solidarity these kind of racist remarks actually would not help, it goes against the solidarity.

    Africa cannot and will not be a testing ground for any vaccine. We will follow all the rules to test any vaccine or therapeutics all over the world using exactly the same rules. Whether it’s

    in Europe, Africa or wherever we will use the same protocol and if there is a need to be tested elsewhere to treat human beings the same way, equally.

    The hangover from a colonial mentality has to stop — and WHO will  not  allow  this  to happen. It was a disgrace actually  and appalling  to hear during the 21st century from scientists that kind of remark and we condemn
    this in  the strongest  terms possible  but  we assure you  that this will not happen in Africa and will not happen elsewhere, in any country. Proper protocols will be followed and human beings will be treated as human
    beings because we’re all human beings.

    00:50:37

    Then after saying this the vaccine development; we’re addressing two issues and we will be announcing as soon as possible, hopefully during this week, a big initiative to accelerate the research and development and production of vaccines and also
    design mechanisms for equitable distribution of the vaccines.

    While we’re looking for vaccines, unless we break the barriers to equitable distribution of the products, whether it’s vaccines or therapeutics, we will have a problem, so we need to address the problem ahead of time, we need to address the problem
    of access or challenges to access ahead of time.

    That’s why we will put together a mechanism and we will appoint senior people from the North and South that will work out the details on how they can accelerate production but at the same time how they can ensure equitable distribution. Solidarity
    is very important here. When a vaccine or a medicine is ready we have to be able to deliver it all over the world.

    There should not be a divide between the haves and the have-nots.

    If we say solidarity, solidarity should be in its full form and I hope each and every individual, each and every human being will go for that kind of solidarity. I thank you.

    TJ        Thank you, Dr Tedros. We’ll take a couple more questions. We go to Yang from Xinhua news agency. Yang, can you hear us?

    00:52:58

    YA      Can I hear you?

    TJ        Yes, we can hear you. Please go ahead.

    YA      As World Health Day is approaching  what do you  have to say to the  front-line medical workers in China and around the world in  the global  anti-virus  efforts? This  question is
    for Dr Tedros. Thank you.

    TJ        If we understood well, the question is what is the message to health workers in China and around the world. Maybe you can repeat the question one more time, please.

    YA      Okay. As World Health Day is approaching what would you say and what message do you want to deliver to the front-line medical workers in China  and around the world  in  the global anti-virus effort?

    TAG    I think I have said it earlier;  as you  know,  this  is  the year of  the nurse and the midwife, 2020. We were ready to celebrate it in a big way and it was supposed to be the main event in our
    Assembly in mid-May. Unfortunately we’re in this situation but  we will  be launching a report tomorrow which is the first of its kind.  It’s a report on the  state of nursing. We will launch it tomorrow during the World Health
    Day.

    00:55:01

    But while launching that report, although it’s about nursing, we will celebrate all health workers, midwives, pharmacists, doctors, you name it. I think the world is now seeing the importance and the central role that health workers play. People,
    when they’re asked, of course, to choose they would say health first because it’s only when you’re healthy that you can aspire to anything, whether it’s wealth or fame or anything. It doesn’t matter if you’re not healthy.

    If you’re not healthy the first thing you ask for is to get back your health and our health workers are making sure that happens and they’re central and very important for any individual. So not only during COVID but during other times too health
    professionals are very important because they are safeguarding that very important aspect of life — that’s health.

    So we have to celebrate them every day. Of course during COVID we can see to what extent they’re sacrificing. We have lost many of them. They’re dying while  saving lives  so my message first is to the public at large; that each and every individual 
    should  recognise, whether it’s during normal times or pandemics like now, the role of health  professionals  and help them, protect them, really appreciate and respect what they are doing.

    To the health workers, although especially during this COVID pandemic you’re working in a difficult situation you should know that your work is the most blessed one, your work is something  special to the extent of losing  your  life 
    while  helping  others to live.  We respect you and appreciate you for that and we also believe in you and that you will do everything to control this pandemic.

    00:58:11

    But you should know that you have – and the world understands – the most important job. We can see the humility which is coming from some leaders because of this pandemic. I know they’re seeing, starting from their own lives, the whole world through 
    a different  prism  and they will also see your role.

    But the most important is not the recognition from the public or from leaders but the internal commitment and passion you have and believing that you’re doing the most blessed thing  and you have all our respect and appreciation and we believe in 
    you,  that together  we will  finish this pandemic. All the respect and appreciation we have to you, the greatest respect and appreciation ever. Thank you.

    TJ        Thank you very much, Dr Tedros. I think this important message will be heard from everyone and we will  conclude  this  press briefing with these important  words from Dr Tedros. We will
    have an audio file available in the minutes to come and we invite you for our next briefing on Wednesday. Thank you.

    TAG    [Inaudible] and see you on Wednesday – tomorrow actually for the launch. Yes, see you tomorrow.

    01:00:18

    Virtual Press Conference on COVID-19- 06 April 2020
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  • Making available free paediatric medicine can accelerate elimination of congenital Chagas disease

    Making available free paediatric medicine can accelerate elimination of congenital Chagas disease

    The donation of an essential antiparasitic medicine can potentially accelerate the elimination of Chagas disease infection in children. A pediatric presentation of benznidazole with accurate dosage and will soon be made available freely to address
    a long-standing gap in the treatment of congenital infections of Chagas disease.  

    The donation, by the Mundo Sano Foundation1 and INSud Pharma2 group to the World Health Organization (WHO), is expected to become effective soon.

    “Making benznidazole freely available for the treatment of newborns and children until the age of 19 will be a game-changer in the fight against Chagas disease” said Dr Mwelecele Ntuli Malecela, Director, WHO Department of Control
    of Neglected Tropical Diseases. “This can save future generations from developing life-threatening and fatal complications and also boost up diagnosis and treatment contributing to congenital Chagas disease elimination.”

    The three-year agreement will make available 108 000 tablets of benznidazole3 – one of the two antiparasitic medicines against Chagas disease. Treatment4 with benznidazole in the early stages of infection can cure Chagas
    disease, prevent or curb disease progression and prevent congenital transmission in pregnant women.

     “We have now added the systematic detection and treatment of all newborns and children under 19 which was not part of  our recent switch from control to elimination of congenital Chagas disease” said Dr Pedro Albajar
    Vinas, Medical Officer, WHO Department of Control of Neglected Tropical Diseases. “In addition, screening of pregnant women at risk of infection who have not had past antiparasitic treatment provides an excellent opportunity for prevention of posterior transmission throughout pregnancy and birth.”

    Each year, an estimated 15 000 children are born from infected mothers. 

    The agreement

    The donation by Mundo Sano Foundation for the duration of the agreement comprises benznidazole:

    • 105,000 tablets of 100mg
    • 3,000 tablets of 12.5mg

    Furthermore, the Foundation may donate funds to support activities associated with distribution of medicines and is ready to consider extending this agreement beyond the specified duration of three years.

    The disease

    Chagas disease, also known as American trypanosomiasis, is a potentially life-threatening illness caused by the protozoan parasite Trypanosoma cruzi (T. cruzi).

    Although considerable progress has been achieved, particularly in reducing vector transmission and screening of blood and organ supply, reaching, diagnosing and providing healthcare for people most affected has been a challenge.

    Currently, under-diagnosis of Chagas disease cases is as high as 90% and under-diagnosis of congenital and paediatric cases is believed not to be lower.

    Globally, an estimated 6-7 million people are infected with T. cruzi.

    The disease is found mainly in endemic areas of 21 continental Latin American countries5. But movement of people to urban areas and to other continents has expanded its transmission through non vectorial routes, such as blood transfusion,
    congenital transmission, organ transplants and oral transmission through food contamination.

    Considering that neglected tropical disease as a growing public health problem in many countries, the World Health Assembly – WHO’s decision-making body – decided in May 2019 to commemorate World Chagas Disease Day on 14 April.

    The inaugural celebration happens this year.

    1Mundo Sano is a nonprofit international foundation working with the public and private sectors, academia, and other international organizations to provide solutions to the affected communities and generate scientific knowledge.
    In 2012, it led a public-private consortium in 2012 to produce benznidazole in Argentina.

    2Insud Pharma (formerly known as Chemo Group) specializes in research, development, manufacture, sale and marketing of active pharmaceutical ingredients and medicinal products for human and veterinary use.

    3In 2017, the United States Food and Drug Administration (FDA) approved benznidazole for the treatment of children aged 2–12, making it the first treatment approved in the United States for Chagas disease.

    4Nifurtimox is also 100% effective in curing Chagas disease if given soon after onset of infection, including cases of congenital infection. It is donated by Bayer who pledged more than 7.5 million tablets for the period 2012-2021.

    5Argentina, Belize, Bolivia (Plurinational State of), Brazil, Chile, Colombia, Costa Rica, Ecuador, El Salvador, French Guiana, Guatemala, Guyana, Honduras, Mexico, Nicaragua, Panama, Paraguay, Peru, Suriname, Uruguay, and Venezuela
    (Bolivarian Republic of).

     

     

     

     

    Making available free paediatric medicine can accelerate elimination of congenital Chagas disease
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  • Chagas disease: providing free paediatric medicine can enhance diagnosis and treatment

    Documentation resulting in the donation of an important antiparasitic medicine for the treatment of Chagas illness to the World Health Organization (WHO) is within the ultimate stage of preparation.

    A 3-year settlement, between the Mundo Sano Foundation1 (Brazil) and WHO, is anticipated to make obtainable 108 000 tablets of the paediatric formulation of benznidazole2 – a first-line medicine towards Chagas illness. Treatment3 with benznidazole within the early levels of an infection can treatment Chagas illness.

    “Making benznidazole freely obtainable for the treatment of newborns till the age of 18 might be a game-changer within the battle towards Chagas illness” mentioned Dr Mwelece Ntuli Malecela, Director, WHO Department of Control of Neglected Tropical
    Diseases. “This is not going to solely save future generations from growing life-threatening and deadly issues however can even increase up diagnosis and treatment.”

    Each yr, an estimated 15 000 youngsters are born from contaminated moms. A freely obtainable paediatric presentation of benznidazole with correct dosage is essentially anticipated to contribute to deal with congenital infections.

    “Treating newborns and youngsters was the lacking hyperlink, as we transfer decisively to advocate for the mixing of diagnosis of an infection amongst pregnant ladies and women of child-bearing age into different surveillance programmes, together with HIV and syphilis” mentioned Dr Pedro Albajar Vinas, Medical Officer with WHO’s Department of Control of Neglected Tropical Diseases.  “Diagnosing and treating ladies of this age group earlier than being pregnant can increase successfully stop congenital transmission.” 

    The settlement

    The donation by Mundo Sano Foundation at some point of the settlement includes benznidazole:

    • 105,000 tablets of 100mg
    • 3,000 tablets of 12.5mg

    Furthermore, the Foundation might donate funds of as much as US$100 000 at some point of the settlement to help actions related to distribution of medicines and conferences. The Foundation additionally makes provision for an extension of this settlement past
    the required length of three years.

    The illness

    Chagas illness, often known as American trypanosomiasis, is a doubtlessly life-threatening sickness brought on by the protozoan parasite Trypanosoma cruzi (T. cruzi).

    Although appreciable progress has been achieved, significantly in decreasing vector transmission and screening of blood and organ provide, reaching and diagnosing individuals most affected has been a problem.

    Currently, under-diagnosis of Chagas illness instances is as excessive as 90% and under-diagnosis of congenital transmission is believed to be even greater.

    Globally, an estimated 6-7 million individuals are contaminated with T. cruzi.

    The illness is discovered primarily in endemic areas of 21 continental Latin American international locations4. But motion of individuals to city areas and to different continents has expanded its transmission by means of non vectorial routes, akin to blood transfusion, congenital
    transmission, organ transplants and oral meals contamination.

    Considering the illness as a rising public well being drawback in lots of international locations, the World Health Assembly – WHO’s decision-making physique – determined in May 2019 to commemorate World Chagas Disease Day on 14 April.

    The inaugural celebration occurs this yr.

    1 Mundo Sano is a nonprofit worldwide basis working with the general public and personal sectors, academia, and different worldwide organizations to supply options to the affected communities and generate scientific information. In 2012, it led a public-private consortium in 2012 to provide benznidazole in Argentina.

    2 In 2017, the United States Food and Drug Administration (FDA) accepted benznidazole for the treatment of kids aged 2–12, making it the primary treatment accepted within the United States for Chagas illness.

    3 Nifurtimox can be 100% efficient in curing Chagas illness if given quickly after onset of an infection, together with instances of congenital an infection. It is donated by Bayer who pledged greater than 7.5 million tablets for the interval 2012-2021.

    4 Argentina, Belize, Bolivia (Plurinational State of), Brazil, Chile, Colombia, Costa Rica, Ecuador, El Salvador, French Guiana, Guatemala, Guyana, Honduras, Mexico, Nicaragua, Panama, Paraguay, Peru, Suriname, Uruguay, and Venezuela
    (Bolivarian Republic of).

    Chagas disease: providing free paediatric medicine can enhance diagnosis and treatment
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  • How to Use Video Effectively

    Video has emerged as one of the most popular marketing tools available in recent years, with the potential results of a skillfully developed marketing video making marketers salivate. Web users regularly interact with video content on the Internet, with viral videos spreading around the world at rapid speed, pulling in views that can easily translate into big sales potential. While creating the next viral hit might feel like a challenge, there are several techniques that can help demystify the video creation process. Use the following tips to ensure a marketing video is well-targeted and effective at reaching consumers…

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  • New WHO Guide to help countries expand access to essential medicines

    New WHO Guide to help countries expand access to essential medicines

    WHO’s   new user guide for countries, ‘Selection of medicines at country level’, is based on the WHO Model List of Essential Medicines. It sets out the key actions countries should undertake to develop and update their own
    national essential medicines lists based on the treatment needs of their populations and their capacity to reimburse payments for medicines.

    The document also aims to support countries in progressing towards universal health coverage. Today, approximately half of the world’s population is unable to  access essential medicines. The large majority of these people live in poorer countries,
    but rising prices of new medicines are also becoming a challenge for health systems in wealthy countries.

    A careful selection of essential medicines is the first step in ensuring a population can obtain the quality-assured medicines it needs at an affordable price.  Countries need to do more to ensure that all people and communities can access highly
    effective medicines. WHO’s new manual is a resource to do just that. 

    The document, intended for policy makers in charge of national medicines and reimbursement lists, aims to increase transparency on how essential medicines are selected. Most national lists of essential medicines have several differences when compared
    with WHO’s model list, which lists only medicines of proven safety and efficacy. Some national lists include medicines that bring little extra benefit to patients. Decision-makers should refer to the WHO global list to gauge the public health
    value of listing certain medicines for their populations.

    The essential medicines concept 

    Essential medicines are: 

    • those that satisfy the priority health care needs of the population
    • selected with due regard to disease prevalence and public health relevance, evidence of efficacy and safety, and comparative cost-effectiveness
    • intended to be available within the context of functioning health systems at all times in adequate amounts, in the appropriate dosage forms, with assured quality and adequate information, and at a price the individual and community can afford.  

    The essential medicines concept is global and forward-looking. It incorporates the need to regularly update medicines selections to reflect new therapeutic options and changing therapeutic needs; the need to ensure drug quality; and the need for continued
    development of better medicines, medicines for emerging diseases and medicines to meet changing resistance patterns.

    Achieving universal health coverage and equity in public health depends on access to essential, high-quality and affordable health related technologies for all. To achieve access for all by 2030, at least two billion more people will need to have access
    to essential health services by 2030.

    In an effort to make the Model List of Essential Medicines more readily accessible, WHO recently developed an electronic version of the list, bringing the traditional EML to computer screens, tablets and smartphones in a freely accessible, downloadable,
    online database.

    Link to manual: Selection of essential medicines at country level

    Link to e-EML: Model List of Essential Medicines

    New WHO Guide to help countries expand access to essential medicines
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  • World TB Day 2020 Newsletter

    World TB Day 2020 Newsletter

    Latest news and updates from WHO

    World TB Day 2020 Newsletter 2

    Dear colleagues and friends,

    World TB Day, this year, comes at a sobering time – as the world grapples with the COVID-19 pandemic. We stand in solidarity with those affected, those at the frontlines of the fight to combat COVID-19, as well as those who continue efforts to support
    those ill with longstanding health problems like TB, HIV and other diseases. However, we cannot forget the millions and their families who battle TB every day and lose their lives to this ancient disease – which remains the world’s top
    infectious killer.

    As eloquently emphasized by WHO Director-General Dr Tedros Adhanom Ghebreyesus in his press briefing on COVID-19 yesterday, “I’d like to remind everyone that although COVID-19 is dominating the world’s attention-there is another respiratory
    disease that is both preventable and treatable, but kills 1.5 million people every year – that disease is tuberculosis”

    “It’s Time”, the focus for World TB Day this year is therefore on urgently accelerating the TB response to save lives and end suffering, even in times of crisis. This will be essential if we are to reach the targets and commitments made
    by Heads of State at the 2018 UN High Level Meeting on TB. 

    We have made important strides against the TB epidemic to date.

    We announced last year, that more people received life-saving treatment for tuberculosis in 2018 than ever before, largely due to improved detection and diagnosis. Globally, 7 million people were diagnosed and treated for TB – up from 6.4 million in 2017
    – enabling the world to meet one of the milestones towards the United Nations political declaration targets on TB and the WHO Director-General Flagship Initiative Find.Treat.All End TB jointly with Stop TB Partnership and the Global Fund. This
    has been a big win for the TB community.

    WHO is working with countries to roll out important guidelines, including a comprehensive package on TB preventive treatment released today, and updated MDR TB guidelines to promote the use of all-oral regimens for patients with drug-resistant TB which
    would be helpful – particularly at this point, when visiting health centers is a challenge. Furthermore, WHO has developed a note to guide and urge countries to ensure continuity of TB services during the COVID-19 pandemic.

    We are strengthening our collaboration with civil society – more information is highlighted in the WHO Civil Society Taskforce Progress Review released today.

    Youth mobilization is being ramped up through the WHO 1+1 Youth Initiative to end TB and the Global Youth Declaration to End TB. Multisectoral accountability is being promoted in countries through our framework and we have finalized a new global strategy
    on TB research and innovation, that will be reviewed by the World Health Assembly.

    Yet, the gains we have made are at risk – if there is any slackening of commitment and action, especially in times of crisis.

    We are at a crossroads and we need to unite forces to take the path of success that will save lives and end suffering.

    I was especially heartened today, to see the TB community coming together like never before. We all took our events to the virtual realm due to COVID-19 lockdowns. The WHO Online Talk Show held this afternoon, had a powerful line up of speakers that included,
    TB survivors and advocates, civil society, high level government representatives, heads of agencies, researchers and partners. As of this evening we have surpassed 10,000 views on YouTube. I also participated in townhalls organized by Stop TB Partnership.
    Our joint efforts have indeed ensured a continuing spotlight on those affected by TB, and clearly shows that no matter what the barrier, we can surpass it if we work together.

    I am proud to stand shoulder-to-shoulder with you all virtually – and recommit to champion End TB efforts till we reach the finish line.

    It’s time to deliver on our promises and ensure no one is left behind.

    It’s time to End TB!

    Dr Tereza Kasaeva
    Director
    Global TB Programme
    World Health Organization

    World TB Day Talk Show

    World TB Day 2020 Newsletter 3

    In the backdrop of the global battle against COVID-19, WHO organized a special online talk show to mark World TB Day 2020. The talk show had a powerful line up of speakers from among TB survivors and advocates, civil society, high-level government representatives,
    heads of agencies, researchers and partners. The video was streamed live on WHO’s Youtube channel crossing over 10,000 views in a few hours. Watch the talk show video

    Spotlight on TB Preventive Treatment

    New WHO recommendations to prevent tuberculosis aim to save millions of lives

    24 March 2020 News release

    Geneva –  New World Health Organization (WHO) guidance will help countries accelerate efforts to stop people with tuberculosis (TB) infection becoming sick with TB by giving them preventive treatment. A quarter of the world‘s population
    is estimated to be infected with TB bacteria. These people are neither sick nor contagious. However, they are at greater risk of developing TB disease, especially those with weakened immunity. Offering them TB preventive treatment will not only protect
    them from becoming sick but also cut down on the risk of transmission in the community. Read more

    The full package is available below and at our World TB Day Campaign Page

    WHO Civil Society Taskforce on TB: Progress Review

    The WHO Civil Society Taskforce provides a platform for meaningful engagement of civil society, building on the commitment of the Director-General, with emphasis on harnessing the untapped potential in engagement with civil society and affected communities
    al all levels. To mark World TB Day 2020, the Task Force has released a Progress Review highlighting key achievements since its formation in 2018.

    Access link here

    WHO eTB guidelines: A digital platform to promote adolopment of TB recommendations

    World TB Day 2020 Newsletter 4

    WHO Global TB Programme / McMaster University

    The WHO Global Tuberculosis (TB) Programme, in collaboration with McMaster University, Canada, is developing a smart platform to improve access to and use of all WHO recommendations on TB prevention and care. The WHO eTB guidelines platform will facilitate
    the adoption, adaptation and implementation (“adolopment”) by countries of recommendations across the continuum of care. This digital platform will provide a variety of users – TB programme managers, healthcare workers including
    nurses, researchers, patients and affected communities – with easy access to all essential information about WHO-s current policy guidance on TB.

    The first set of recommendations on TB preventive treatment were released on this new platform on World TB Day.

    WHO eTB guidelines platform

    Infographic

    TB and COVID-19

    24 March 2020 News release

    Geneva –  As the world comes together to tackle the COVID-19 pandemic, it is important to ensure that essential health services and operations are continued to protect the lives of people with TB and other diseases or health conditions. Health services,
    including national programmes to combat TB, need to be actively engaged in ensuring an effective and rapid response to COVID-19 while ensuring that TB services are maintained. Read more

    Let’s never forget: It’s time to end TB

    Ksenia Schenina

    World TB Day 2020 Newsletter 5

    Ksenia Schenina

    24 March 2020 Photo story

    On World TB Day 2020, the theme – “Its time” – stresses the urgency to end the TB epidemic. TB survivor and advocate, Ksenia Schenina, talks about her struggle with the disease, the persistence of stigma and the role that remembrance can play
    in fighting it.   Through her TB memorial project, she aims to remember those who passed away from this terrible and ancient disease. “We do it to show what kind of people they were – what kind of things they liked, what kind of music
    they listened to and what their favorite movies were; if they liked fishing or dreamt of a flight to space,” she says. Read more

    Commentary

    To end TB, we must invest in research and innovation

    24 March 2020 Commentary

    If the world is to get anywhere near ending TB, a disease that killed more than 1.5 million people in 2018, something significant needs to change.

    TB remains the world’s leading infectious killer and yet, in the last 50 years, only three new drugs and regimes have been developed to combat the disease. “What we need is more research and more tools in the pipeline; better diagnostics,
    more effective vaccines, and safer, shorter drug regimes,” explains Dr Tereza Kasaeva, Director of the World Health Organization Global Tuberculosis Programme. Read more

    Emily: A Day in the Life of a TB Nurse

    World TB Day 2020 Newsletter 6

    Maria Emily C. Ballesteros

    Watch this story of Emily, a nurse managing the tuberculosis (TB) program of the City Health Office in Tuguegarao City. Her dream for Tuguegarao is to one day see zero TB cases and that no one dies from this infectious disease. Nurses and healthcare workers
    play a critical role in TB prevention and care. It’s time to invest in them to improve healthcare for all. We thank all the nurses, midwives and healthcare workers working to #EndTB! Watch the video

    Updates and messages

    New research tool supports scale-up of digital technologies to End TB

    24 March 2020 TDR news item

    National anti-tuberculosis efforts are increasingly involving digital technologies, such as mobile applications to support treatment adherence and electronic surveillance systems that enable real-time monitoring of a country’s TB situation. Read more

    World TB Day 2020: It’s Time for solidarity

    24 March 2020 HIV/TB news item

    At this unique time in history when the world is grappling with the COVID-19 pandemic, the WHO Department of Global HIV, Hepatitis and STI Programmes stands in solidarity with governments and communities as they seek to maintain health services
    and continue to address the needs of patients suffering from HIV and tuberculosis (TB).  Read more

    New, shorter treatment to prevent TB to be rolled out in five high TB burden countries

    24 March 2020 news item

    Three-month regimen expected to prevent TB in those at highest risk of developing the disease, including people living with HIV and children under the age of five
    Today, the Aurum Institute and its partners, as part of the IMPAACT4TB project, announced that five high-burden TB countries will roll out a new, shorter drug regimen (known as 3HP) to prevent TB. The announcement comes as countries around the world mark World TB Day, which takes place every year on March 24th. Countries that will initially provide the new regimen with funding from Unitaid, U.S. PEPFAR and the Global Fund include Cambodia, Ethiopia, Kenya, Malawi, South Africa and Zimbabwe. More than 120,000 patient courses of 3HP will be delivered by the project to 12 countries in 2020. An additional 1 million patient courses are expected to reach low- and middle-income countries by the end of the year, through the combined support of Unitaid, Global Fund, the Stop TB Partnership’s Global Drug Facility (GDF) and PEPFAR. Read more
    World TB Day 2020 Newsletter
    Read More
    https://www.who.int/news-room/detail/30-03-2020-world-tb-day-2020-newsletter

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  • Presidential Order Not Enforceable Without Legal Backing! By Femi Falana

    Presidential Order Not Enforceable Without Legal Backing! By Femi Falana

    Presidential Order Not Enforceable Without Legal Backing! By Femi Falana 7

    Presidential Order Not Enforceable Without Legal Backing! By Femi Falana 8


    Following the national broadcast of President Muhammadu Buhari on the COVID-19 pandemic on Sunday, some lawyers have questioned the constitutional validity of the restriction of locomotion of people in Abuja, Lagos and Ogun states. No doubt, the President is empowered to adopt any measures deemed fit to combat the dangerous disease but such measures have to be spelt out in a Regulation made pursuant to section 305 of the constitution or under the Quarantine Act. Otherwise the presidential order on restriction of movement in the affected areas cannot be enforced by the police. 

    Even though civil rule was restored in the country 21 years ago the psyche of the political class has not been demilitarised. Hence, decisions taken by rulers are required to be obeyed “with immediate effect” without any legal backing. But in Okafor v Governor of Lagos State (2016) LPELR-41066 (CA) the Court of Appeal called on all authorities to appreciate the need to govern the country under the rule of law. Thus, the directive of the Governor of Lagos State restricting the movement of citizens and residents during the state’s monthly environmental sanitation exercise was struck down because of its unconstitutionality. It was the unanimous view of their lordships that the arrest of appellant for flouting the order or directive of the governor was completely  illegal. According to Georgewill , J.C.A. 

    “It is my view, that democracy thrives more on obeying and promoting the rule of law rather than the whims and caprices of the leaders against the lead. I find the conduct of the Respondent in not only persecuting the Appellant, yes that is what in my view it amounts to when a free citizen of this great country such as Citizen Faith Okafor, is put through the rigours of criminal process for an offence not prescribed in any written law but merely on the directive of the governor of the Lagos State. An action which if allowed to thrive in a democracy such as ours could confer on such office holders infinite, absolute and autocratic powers contrary to the clear provisions of the constitution of the land, to which both the leaders and the led are subject. I  refuse to allow such autocratic, absolute and infinite powers to fester upon our nascent democracy.”

    Lawyers who are saying that the law should  be completely relegated to the background in combating the coronavirus pandemic reminds me of the dissenting judgment of Lord Atkins in the case of Liversidge v Anderson 1944 UKHL 1. While accusing his learned brethren of being “more executive minded than the executive”,  his Lordship said inter alia:

    “In England, amidst the clash of arms, the laws are not silent. They may be changed, but they speak the same language in war as in peace. It has always been one of the pillars of freedom, one of the principles of liberty for which on recent authority we are now fighting, that the judges are no respecters of persons, and stand between the subject and any attempted encroachments on his liberty by the executive, alert to see that any coercive action is justified in law.”

    However. while the nation’s armed forces should be commended for making their medical facilities available to members of the public in the fight against the highly dangerous virus the plan to dispatch armed soldiers to the streets to enforce the COVID-19 guidelines should be shelved because it is  illegal. For the umpteenth time, I am compelled to draw the attention of the military authorities to the case of Yussuf v Obasanjo (2005) 18 NWLR (Pt ) where Salami JCA (as he then was) held that “It is up to the police to protect our nascent democracy and not the military, otherwise the democracy might be wittingly or unwittingly militarized. This is not what the citizenry bargained for in wrestling power from the military in 1999. Conscious steps should be taken to civilianise the polity and thereby ensure the survival of and sustainance of democracy.”

    In the same vein, in the celebrated case of All Progressive Congress v Peoples Democratic Party (2015) LPELR 24349  Aboki JCA held that the President lacks the power to call on the Armed Forces to restore law and order in any part of the federation without the approval of the National Assembly as provided in sections 217(2) and 218(4) of the constitution as amended. His Lordship reminded the Federal Government of its legal obligation  “to confine the military to their demanding assignments especially in these trying times of insurgencies and encroachment into the country’s territories…”

    Finally, just last week the satanic Boko Haram force was reported to have massacred 47 Nigerian troops and 92  Chadian soldiers in two separate attacks. In view of such enormous challenge our patriotic armed forces should concentrate efforts on the counter insurgency operations being carried out in the north east region while  the police and allied security agencies are allowed to enforce the COVID-19 regulations and guidelines.

    Opinion

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    Femi Falana

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  • Coronavirus confinement challenges intelligence services

    Coronavirus confinement challenges intelligence services

    The home confinement of hundreds of millions of people worldwide to halt coronavirus contagion has presented intelligence services with a challenge: monitoring an explosion in internet traffic, above board and not, even as their own capacity is reduced.

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  • COVID19: Restrictions On Peaceful Assembly And Movement Without A Law Or State Of Emergency Is Unconstitutional By Inibehe Effiong

    COVID19: Restrictions On Peaceful Assembly And Movement Without A Law Or State Of Emergency Is Unconstitutional By Inibehe Effiong

    COVID19: Restrictions On Peaceful Assembly And Movement Without A Law Or State Of Emergency Is Unconstitutional By Inibehe Effiong 9

    COVID19: Restrictions On Peaceful Assembly And Movement Without A Law Or State Of Emergency Is Unconstitutional By Inibehe Effiong 10


    A follower on Twitter asked me on Saturday whether it is “constitutional” for the government to restrict religious and social gatherings because of Coronavirus?

    By virtue of Section 45 of the 1999 constitution, the rights to peaceful assembly and free movement can be interfered with in the interest of public health and public safety. Is Coronavirus a threat to public health and public safety? The answer is obviously in the affirmative.

    Section 14 (2)(b) of the constitution states that “the security and welfare of the people shall be the primary purpose of government.”

    However, I urge President Buhari to declare a state of emergency throughout the federation in line with Section 305 of the constitution.

    Section 305 (3)(d) of the constitution, allows for a state of emergency when “there is clear & present danger of breakdown of public order and public safety in the federation or any part thereof requiring extraordinary measures to avert such danger.” COVID-19 is a clear and present danger to public safety.

    Unlike in the United States, States in Nigeria cannot declare emergency. A governor supported by 2/3 members of the House of Assembly can only request the president to do so for them as stated in Section 305 (4) of the constitution. This is an example of the fraudulent nature of our federalism.

    Since there is no special law to my knowledge, apart from laws establishing national and States emergency management agencies, to address public health crisis, it is necessary for the President to declare a state of emergency in Nigeria to address the outbreak of Coronavirus.

    In the absence of a law enabling these restrictions to social and religious gatherings, the legality of these measures is questionable. This is because fundamental rights cannot be derogated from except as prescribed in a law that is “reasonably justifiable in a democratic society.”

    It is either a law is urgently enacted across the volatile states or the President invokes the state of emergency clause. As at today, there is no strong legal basis for restricting gatherings. None of the governors or the President has issued even an ordinary ‘Executive Order’.

    In the United States for example where we copied our presidential system, President Trump declared a national emergency, and at least 48 States in the US have also declared emergency due to COVID-19. The American Congress also passed the Families First Coronavirus Response Act.

    In Nigeria, we are resorting to our usual militaristic way of doing things by relying on arbitrary executive fiat to tackle COVID-19. Nations do not become great just by the “good intentions” of politicians. Nations become great principally by adhering to the rule of law.

    In the light of the foregoing, I strongly urge the federal and state governments to urgently take steps to address the apparent legal loopholes in their efforts to tackle Coronavirus. It is obvious that Nigeria is not prepared for an outbreak. We are doing trial and error.

    We need a legal framework; not only to give legal backing to the restrictions on the fundamental rights of Nigerians to religion, association, assembly, movement, etc., but to also provide for reliefs for families and victims of COVID-19.

    We should not wait for the worst to happen.

    I wish to draw the attention of the government to the decision of the Court of Appeal in the celebrated case of Okafor v. Lagos State Government (2017) 4 NWLR (Pt. 1556) 404 where it was held that disobeying the “order” or “directive” of a governor is not a criminal offence.

    In that case, Lagos State issued an order restricting movement during environmental sanitation, Okafor was arrested for disobeying the order. The court declared the arrest illegal and unconstitutional since there was no law that criminalized violation of the governor’s order.

    Without a law or a state of emergency, it is illegal to arrest anyone for violating a mere executive order. Emotions cannot change the law. If religious leaders whose places of worship have been closed decide to challenge the closure in court, the government will likely lose.

    I hope the government at all levels will listen to the voice of reason and initiate appropriate legal frameworks to support the containment of COVID-19. It is either we are a country of laws or a banana republic.

    We should not yield to authoritarian rule because of expediency.

    Inibehe Effiong is a Lagos-based legal practitioner and human rights activist

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    COVID19: Restrictions On Peaceful Assembly And Movement Without A Law Or State Of Emergency Is Unconstitutional By Inibehe Effiong
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