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Monkeypox, COVID-19 & Other Global Health Issues Virtual Press conference transcript - 17 August 2022

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  • Monkeypox, COVID-19 & Other Global Health Issues Virtual Press conference transcript - 17 August 2022

    17 August 2022 | Press briefing transcript

    Overview

    TJ Hello to everyone from WHO Headquarters here, in Geneva, on this Wednesday, August 17th. My name is Tarik and I wish you welcome to a regular WHO press conference on global health issues. I will start by introducing our speakers here, in the room, and those who are online.

    00:00:40
    Today, we have Dr Tedros, WHO Director-General. We have also Dr Socé Fall, who is Assistant Director-General for Emergencies Response. With us is also Dr Mariângela Simão, Assistant Director-General, Access to Medicines and Health Products. Dr Sylvie Briand is Director of Global Infectious Hazard Preparedness, Dr Rosamund Lewis is Technical Lead for monkeypox, and Dr Abdirahman Mahamud is Incident Manager for COVID-19.

    Online, with us, is Dr Mike Ryan, Executive Director of Health Emergencies Programme, and we also Dr Rogério Gaspar, who is Director for Regulation and Prequalification. We may have some other WHO experts also joining and who may answer questions. ...

    00:11:31
    Are there any other vaccines that we should be looking at to respond to the monkeypox outbreak and, more broadly, given this resurgence of, quote/unquote, all diseases such as polio or even monkeypox is there a broad theme why this is happening? Is this climate change? Is this global populations performing better surveillance? Is it a long tail effect of the pandemic on population immunity? I appreciate it’s a broad question but I’d be curious to hear your thoughts. Thank you.

    TJ Thank you, Donato. There are really two distinct questions here. Maybe we start with the first one on monkeypox vaccines. Maybe Dr Simão can start there and then, on the second question, Dr Briand may help.

    MS Thank you. Thank you, Tarik, and thank you, Donato, for this question. Actually, WHO is in touch with Bavarian Nordic specifically but also with the other manufacturers, first to understand supply and the hurdles to increase manufacturing capacity and availability of therapeutics and also of vaccines and, second, to discuss potential opportunities for technology transfer and voluntary licensing of these technologies.

    We’re talking about this in the context of where we do need more data about both vaccines and the therapeutics. So, this is work ongoing and we are happy to update as we get more information and the negotiations with these manufacturers continue. Thank you.

    00:13:15
    TJ Thank you, Dr Simão. Maybe Dr Briand can take the second question on re-emergence of pathogens.

    SB Thank you very much for this question. Indeed, we have seen in the recent past a lot of disease emerging and others re-emerging and I think it’s important to differentiate the two phenomena. Emergence is something that we know most of the emerging viruses are coming from animals, this the case for monkeypox, and they infect humans.

    At the beginning it’s only sporadic cases but if the virus finds the right environment then it can evolve and become more fit for humans, and then you can see localised transmission and further amplification. Again, if the conditions are supportive for that, like high human density, very close contact, then you can have an outbreak and this is what we have seen with monkeypox.

    Initially, it was in animals, then it went to some humans, and then we had localised outbreak, and now we have a multi-country outbreak. This is for the emergence and of course there are many factors driving the emergence. You mentioned some of them, the climate change, but also human density in certain populations, certain human behaviour can also foster this amplification.

    Also, what is really important is the fact that we can stop those outbreaks at the source but for this we need a very good health system, very good collaboration, with a One Health approach. That’s why it’s so important to strengthen universal health coverage and primary healthcare because this is why and we can then stop those outbreaks at source with good surveillance, good healthcare system and stop the spread when outbreaks are still localised.

    00:15:25
    For the re-emergence, sometimes there are other factors playing out. In particular, for a disease for which we do have tools for the control, like polio, like measles, the fact is that it’s often because the vaccine coverage is too low that those diseases re-emerge. It’s very important to understand that vaccine coverage is a very, very important indicator of the protection of human beings against those diseases and it’s very important, therefore, to make sure that all children get access to these vaccines in due time so that we can make sure that there is no cohort of human beings that are unprotected. We have the tools but we need to use them and this is what is really important to prevent re-emergence. Thank you.

    TJ Thank you, Dr Simão and Dr Briand. Just to correct that title. Dr Sylvie Briand is Director of Epidemic and Pandemic Preparedness and Prevention Department. With that, we will go to the next question. We have Erin Prater, from Fortune, online. Erin, go ahead.

    EP Hi. Thank you for taking my question. Just curious if there were any updates as far as mutations in the monkeypox virus. I believe CDC officials had said a month or two ago that they had seen at least two different strains. Curious if there’s any update. Thank you.

    00:16:57
    TJ Thank you, Erin. Dr Lewis.

    RL Thank you very much. We do continue to monitor the strains that are reported through genome sequencing. That is put in accessible websites where scientists, evolutionary biologists and pox virologists can look and review. So, we have seen mutations but at the moment we don’t have any information really on what that means in terms of the behaviour of the virus, itself, or how it interacts with the human immune response. We’ll continue to monitor that space.

    TJ Thank you, Dr Lewis. We will now go to Helen Branswell, from STAT. Helen, can you please ask your question?

    HB Thank you for taking my question, Tarik. In the Director-General’s opening remarks he mentioned that some countries are starting to provide WHO with some evidence about the efficacy of the monkeypox vaccines. Could somebody please elaborate on what is being seen? Thank you.

    TJ Thank you, Helen. Dr Lewis.

    RL Thank you, Helen. We don’t have any randomised control trials of these studies in the context of this particular outbreak, so we don’t have direct clinical efficacy studies, as I say, in the context of this monkeypox outbreak at the moment. What we are beginning to see is some observational studies reporting, for example, persons who may have had post-exposure prophylaxis. After being exposed to monkeypox they may have had the vaccine. Again, just a couple of reports are coming out.

    00:18:34
    We have known from the beginning that this vaccine would not be a silver bullet, that it would not meet all the expectations that are being put on it and that we don’t have firm efficacy data or effectiveness data in this context. What we are beginning to see is that some cases are being reported, perhaps as breakthrough cases, either following post-exposure prophylaxis, which is meant to reduce disease severity, or following preventive vaccination, which is meant to, of course, reduce infection.

    We don’t yet have any, as I say, randomised control trials specifically on that but the fact that we’re beginning to see some breakthrough cases is also really important information because it tells us that the vaccine is not 100% effective in any given circumstance, whether preventive or post-exposure. We cannot expect 100% effectiveness at the moment based on this emerging information.

    Again, this is not new. In the past, based on a very limited study from the 1980s, it was already suggested that the smallpox vaccines in use at that time, which were also powerful replicating vaccines, might offer about 85% protection against monkeypox and that was really one study in an area where some people were vaccinated and some people were not, so they could compare that.

    00:19:50
    However, that’s really all the information we had and the vaccines we have now are developed in order to be safer but they’re also non-replicating. So, we are not expecting 100% efficacy for these vaccines for the prevention of monkeypox. We don’t know the exact information.

    What we’re seeing are breakthrough cases, which are not really surprises, but it reminds us that vaccine is not a silver bullet, that every person who feels that they are a risk, and appreciates their own level of risk, and wishes to lower their own level of risk have many interventions at their disposal, which includes vaccination where available but also protection from activities where they may be at risk, reducing the number of sex partners, avoiding group sex or casual sex and, specifically, when a vaccine is in fact administered, waiting until that vaccine has the time to produce a maximum immune response.

    In the case of MVA vaccine, this is two weeks after the second dose. So, again, it’s not a magic bullet. People do need to wait until the vaccine can generate a maximum immune response but we don’t yet know what the effectiveness will be overall. ...

    TJ Tarik Jasarevic TAG Dr Tedros Adhanom Ghebreyesus MS Dr Mariângela Simão SB Dr Sylvie Briand RL Dr Rosamund Lewis MR Dr Mike Ryan AM Dr Abdirahman Mahamud SF Dr Ibrahima Socé Fall DM Donato Mancini EP Erin Prater HB Helen Branswell BR Bianca Rothier SC Slavea Chankova VS Vijay Shankar NL Nina Larson DL Dong Lyu GS Gabriela Sotomayor SA Simon Ateba LP Lauren Pelley

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