WHO Press conference on Ebola 5 March 2021

Good morning and thank you for joining WHO press conference.

WHO will present today an overview of its activities in response to the Ebola outbreak in Guinea and in the Democratic Republic of the Congo and our preparedness work in neighbouring countries in the middle of the COVID-19 pandemic.

We will have with us from Geneva, Dr Ibrahima Sosefol.

Dr Sosefol is Assistant Director general, Emergency Response and from Guinea Doctor Michel Yau, Director Strategic Health Operation Doctor George Alfred Kizerbo, who is our representative in Guinea, and Mr Guy Abdul Salam.

He's the regional emergency director in our office in Afro, but he's also in Guinea and now without any further delay would like to hand over to Doctor Saucy for an overview of the situation.

Over to you doctor Saucy Merci Fadella.

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This priest, Mercy Mercy Doctor Faux Mcnacio told you Doctor Kizerbouzavella Pal of the Ebola outbreak in Guinea, who has conducted a rapid risk assessment and graded the event as very **** level of risk in the country and **** level of risk in the region.

In response to this risk, we have been aligning our efforts with all partners in support of the National Strategic Response Plan of Guinea.

We have developed and deployed a such capacity in the ground and we have also worked with the community and engage all stakeholders to be able to interrupt this outbreak as soon as possible.

The regional dimension has been taken into account with Regional Ministers of Health meeting WHO who committed to step up the preparedness and readiness plans.

In terms of epidemiological situation, as of yesterday, a total of 18 cases were reported, 14 were confirmed, including four deaths.

This gives a case fatality rate of 44.4%.

One health district is active, it's 0 core and six health districts are on our left.

In terms of contract racing, 418 of the five O 9 contacts were followed up, which is a good follow up rate but needs to be sustained.

In terms of vaccination, the ring vaccination has reached 1604 participants, including 237 **** risk contacts, 1028 contacts of contacts and 300 and 339 probable contacts, including 482 healthcare workers.

We must remind that this outbreak has already taken the lives of two health workers.

In terms of case management, 7 of the 8 confirmed patients are benefiting from the innovation of new therapeutics in 0 core, which is supposed to be reducing the case fatality rate.

In terms of risk communication and community engagement, we are working closely with the community with an health area strategy.

We want to be as close as possible to the communities and the district health workers.

In doing so, we are engaging traditional leaders, including also traditional practitioners and we are going to families and communities to discuss with them to to listen to them and see what are the understanding of the disease, what is the the fears of, I mean, the preoccupations of a community so that we can increase the the success of our interventions.

Safe and dignified barrier has started with the support of Red Cross and other NGOs.

This is an essential element of prevention because we know that this outbreak started following the funerals of a nurse who died and was later considered as we index case.

In terms of challenges, we need to strengthen the coordination of all partners.

We are working under the UN coordination.

WHO and other health related agencies like UNICEF are are leading the health cluster, but we are bringing on board all the NGOs, all the actors on the field.

We are also engaging donors and financial institutions.

We need to talk to the World Bank, African Development Bank, USAID and other donors so that we can all come together and support the national strategic plan.

So this is what I have to say and to recognise really the involvement of the Guinean workers who went to DRC.

These are the first line actually, and they are so, so, so strong and recognised by the community and doing models as we speak today.

Thank you, Doctor Kizerbo, next speaker please.

Mr Abdul Salem, you have the floor.

[Other language spoken]

Thank you very much.

[Other language spoken]

I came from the field last night and I found their integrated, very motivated team and almost all the pillar of the response are working.

The treatment centres are fully functional, the laboratory are also functional and the experts that are on the field are training for refreshing, training FK workers for prevention of transmission in in their work and also the vaccination that are working.

Minister of Health of the neighbouring country in Guinea at organised at the beginning of this last week meeting to concert about, you know this outbreak.

And as you know we did readiness training, readiness assessment and during the readiness assessment it was found that some countries was less ready than others.

And in terms of pillar, some pillars was particularly concerning because they did not have experience like none of the country is ready to conduct vaccination and as you may know the vaccine against Ebola is has a lot of logistic requirement like it has to be stored on -80° and all.

None of the country was completely ready for vaccination, but those neighbouring country has agreed upon cross-border cooperation and coordination to control the outbreak.

They also agreed to set up a coordination mechanism, enhance the surveillance and facilitate import regulation for vaccine and drugs as well.

And actually we have some concern in the field.

For example, the anthropologists are doing an assessment to see exactly how the population are exceeding the response and what are the best ways to include them into the response.

We are also working with all partners in order to put in place an excellent collaboration and work as one team.

Thank you very much.

[Other language spoken]

Okay, thank you very much.

In addition to what colleague have said, I'm right now in the recording that is one of the epicentre and as highlighted by the last speaker is close to the border of different countries and from our experience preparedness that's bad.

We recall that when we had few cases from DRC to Uganda during the last outbreak, it was quite managed and this was due to the preparedness.

So from the meeting we had in Kanaki mentioned by my colleague, where we felt that there is a huge commitment and countries are not starting by scratch.

I will maybe update a bit on the DRC.

In addition to what has been said in DRC, we have now 11 cases and four deaths during the last three weeks.

Nine of these 11 cases were reported.

They since 8 days of no case where was reported.

But the challenge is that we are not yet there.

So we have to continue a strong surveillance system that has improved since the the beginning of the declaration of the outbreak.

At the beginning, the alleged was a bit well and this is the challenge in the two outbreak where we have the human capacity, there is a need for support, support to ensure that all the innovations are implemented including vaccination based on a clear strategy.

Due to the limited stock of vaccine that we have to deal with different outbreaks and if they outbreak spread to other countries, we have limited stock.

So an appropriate strategy to ensure that we control the outbreak with the minimum stock that we have and of course, using a different treatment and also learning from the past experience, strengthening the community engagement.

We cannot win this battle without the community.

It starts in the community and end in the community.

So these are issues that we learn and from the feed here we are ensuring that also we have a stronger partnership so that at least we can put all the effort in the same direction to control the outbreak.

So I will start here and being ready to answer some of the questions.

Other.

Thank you, Doctor Yao.

We will start the question from journalist.

Let me just see who wants Catherine Fionca Bokonga, you have the floor.

Catherine, thank you for the la merci beaucoup.

Thank you to the gentleman for briefing us this morning.

I will ask if you don't mind a couple of I, I, I would like to have some details about Doctor Fal Bonjour, Merci de Trella, the, the ultra epidemic Purefair de Elmo de Creer de Manera disposition.

And this is also complementary question to Doctor Kizerbo who spoke about new therapeutics, if he could please be a bit more clear about the new therapeutics.

And I wanted to know if Doctor Mr Salam did understand well that he is in Guinea because he said he's in the field, but in, in DRC or Guinea.

[Other language spoken]

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Therapeutic don't call a Russia's clinical don't call a therapy monoclonal.

Doctor Kizerbo, do you want to to respond to or you are OK to have to watch the associate just say these new therapeutics were procured for response in Guinea and they were approved by the Ethics Committee.

There are investigators and Co investigators conducting the the administration and the teams are actually trained.

These are the same team, but we're working also in DFC.

So the expertise and the capacity being used and all the regulatory precautions are being taken to use this and reduce the mortality of this outbreak in in Guinea.

[Other language spoken]

Any other speaker who wants to to add something if not Catherine?

Dr Sussi Fall is in Geneva, but the three other W2 expert are all in Guinea.

I would like now to doctor Mr Abdul Salam, do you want to take the floor based in Brazzaville and I yesterday I was in Dhirekore and last night I came to Punaki to meet partners.

Over to you.

OK, Thank you for the precision.

Now I would like to give the floor to Christiane Ulrich from DPA Christian.

Hello, Christiana with the German Press Agency.

Thank you for the briefing.

I wonder whether you could give us a bit of a timeline to so that we can see does this, do these outbreaks accelerate or are they at a stable pace at this point?

If you could just give us an idea of what happened in the last seven days up to date.

And then I have a more general question.

It's very worrying that these outbreaks seem to come more often.

[Other language spoken]

Do you know where the first case has got infected?

Is was is a transmission from from the wild and are you worried about this?

Is there some research going on into how we can prevent more and more of these kinds of outbreaks happening?

[Other language spoken]

Over to you.

Who wants to take this question?

Doctor Sauce, you have a floor.

[Other language spoken]

This is a very important question.

[Other language spoken]

Actually, I established the last one.

The occurrence of, you know, multiple outbreak of Ebola.

You know, if you look at the the determinant and the source of infection, this is coming from the wildlife.

This has a lot of diseases and we have now more interaction between the human population and the wildlife and the forest.

If you look at level of deforestation, you know, mining activities and so on, we will see more and more, you know, viruses jumping from, you know, wildlife to to human.

And we have seen it for so many other outbreaks.

So really prevention is the first thing to do.

But to be able to prevent, we need to have more effective tools, more effective vaccine and in quantity.

That's why I was saying we need to continue advocating for more vaccine.

And we are working now to see the the duration of protection from this vaccine.

If you are confident that they can protect for a long period, it will help us to have a more preventive approach based on risk because we know exactly where the niches of Ebola where the risk.

So by using preventive vaccination in the future, we'll be able to prevent this type of big outbreak.

I'm looking at the dynamic of the outbreak right now.

We cannot talk about acceleration or deceleration.

We are still, you know, it is still very soon to to talk about plans.

But if you look at the last week, I think I've seen maybe six or seven additional cases.

But since the team are still investigating, you are not in a position to give a full picture.

We need to make sure that we haven't missed any case, we haven't missed any **** risk contacts that can lead to other, you know further transmission.

So investigations still going on to be able to describe the timeline from the index case to where we are right now and we'll come back to you with more update in the future.

[Other language spoken]

Yes, just to add on what Doctor Susefala said, if we look up DRC, the alert level has significantly increased.

They are now around 150 alert per day is a good a good pattern.

It's meant that at least you have a sensitive system in the community that can capture any Ebola like disease within the community, isolate and treat.

So they are getting almost there up to speed and since the last eight days there is no case.

But in Ebola we have a cycle of three weeks.

So let's still wait to see if this trend will be sustained in DRC.

In terms of again we still have active cases in last yesterday we had one additional case and we still not at kind of 100% of the contact tracing.

There are contacts that have not been seen because of movement or a bit of community resistance.

So community sensitization starts at the earlier stage and it's also improving.

[Other language spoken]

We have an average of 10 alerts per day.

This need to be increased significantly and all the partners and including W2 here are working hard to ensure.

So in Guinea is very, very early to see the spread.

Investigation is still on.

Our sequencing is still on to understand what was the the initial case, how the initial case was infected.

So these are what I can say in addition to what Doctor Sosi Sosi mentioned other I think.

Thank you very much.

Just just to add a couple of words to the question related to recurring outbreak that are happening now and what we are doing for that.

Indeed various recurring outbreak and the period between outbreak is decreasing more we are evoluting.

This is due first to the improvement of the detection because of surveillance.

Almost all the African countries now have developed a new type of surveillance that is working.

And also the laboratory capacity that was that was tested in the past in different continents and may take weeks before to come back has improved in Africa.

And also we should add that there's a lot of capacity to travel from community to community.

Some communities that are used to stay in their place for all their lifelong are moving which make the outbreak happening often being detected often and also the transmission, geographic transmission is increasing.

Over to you.

[Other language spoken]

I think that Christian has a follow up question.

Christian over to you.

Sorry.

Could you just repeat the the case numbers as of today in Guinea and in DRC?

[Other language spoken]

Where what the colleagues have said in terms of early detection, we are training and strengthening capacity in integrated disease surveillance and response, including community based solar balance and laboratory capacities also for surveillance.

And there is a project in Guinea called PREDICT, which is looking at the One Health approach to see what what could be the sources of resurgence of these hemorrhagic viral fevers, LASA, Ebola.

And this is looking at the interface of many human interactions to try to understand better the source of these outbreaks.

Dr Isabel, can you give us the latest number?

I think 1818 cases, OK, For Guinea it's 18, but for Congo, the latest number is 11.

[Other language spoken]

Of course not.

It's not the same dynamic because if you look at Congo over the last weeks, it was the last week I think I've had two cases.

So the situation is different.

So for Guinea, we have 18 cases, 14 are confirmed and four deaths.

This is correct.

[Other language spoken]

Now I would like to give the floor to Nina Larson from IFP.

Nina, you have the floor.

Thank you for taking my question.

[Other language spoken]

I was wondering the mention about the limited vaccine stocks, how, how concerned are you about or actually how, how if you could repeat the number of vaccines that have been given?

And if you think that that for the moment is enough to rein in the to help rein in this outbreak And how likely do you think that this will jump to neighbouring countries?

And if you could then maybe say, you know, how many vaccines do you actually have available and what would that mean if, if this jumps to neighbouring countries?

[Other language spoken]

It's just the last time there was an Ebola outbreak in Guinea, the community interaction was was quite complicated and complicated the response.

Are you seeing, is it similar now or, or has it improved from last time?

If you could talk a little bit about that.

[Other language spoken]

Yeah, I will start with the question on vaccine.

Looking at the Met vaccine we are using for the response.

Overall, we have more than 500,000 doses available worldwide or we started resending around 30,000 doses to Guinea.

And it's important to highlight that we are using the vaccination, meaning that we are vaccinating the contacts of cases, the context of contacts and probable contacts.

So with this strategy, you are able to to work, you know, in an appropriate manner to control this type of outbreak.

But in the future, we need more vaccines if you are going to move to a preventive strategy for Ebola.

And so we are also working with neighbouring countries to use Johnson, Johnson vaccine, as I said for more preventive action for, for health workers in at risk area.

At this stage it's still limited and it can be controlled with the available vaccine because we have had enough experience from the Congo where we have used more than 300,000 vaccines over 2 years.

And in terms of projection, Doctor Kizerbo talked about the risk assessment you have done.

The risk is very **** in neighbouring countries because if you look at the borders in Africa, you there is no delineation.

You have the same families, you know both sides, people moving from 1 village to another.

This is really very artificial.

So when we have an outbreak in a, you know, border, we consider that we have almost an outbreak in another country.

But so far all the a lab you have received from other countries like Liberia or Sierra Leone or tested negative, but the risk remain very ****.

[Other language spoken]

Anyone else who wants to speak?

Doctor Kizerbo, you have the floor, Sir.

In terms of community engagement, it is important to learn the lessons from the last outbreak, where we launched the vaccination campaign in Wake Day.

A few kilometres from there is the village of Warman.

This is where a team of officials and responders were tracked and actually killed in the last outbreak in 2015.

So we need to take back into account when we engage with communities to make sure that we listen to them, their interpretations of the disease, their understanding of interventions and their buying so that we can move together and engage all the communities.

So this message was repeated yesterday when we were with the officials and the responders in 0 quarry.

In terms of number of people vaccinated, 1604 people were vaccinated and these are **** risk contacts, 237 contacts of contacts 1028, 339 probable contacts.

So we broaden the, the, the rim so that we are more sure to to to interrupt the transmission and 482 healthcare workers because we know infection prevention and control is still weak in our healthcare facilities and these healthcare workers are really exposed.

Thank you, doctor Kizerbo.

[Other language spoken]

Elizabetha, you have the floor.

[Other language spoken]

Thank you for taking my question.

Actually, my question about not about Ebola, but about another outbreak of the disease, unknown disease that was found like, you know, this week in the reports, several media reported that in February in the Democratic Republic of Congo, at least 15 persons died from an unknown disease.

[Other language spoken]

Do you know, have you started the the investigation on what these diseases and do you know any information about this?

[Other language spoken]

Doctor Sossefol, you have the floor.

[Other language spoken]

Thank you very much.

In fact, this is an event we detected in our surveillance system also from open source and we have been in close communication with our county office in Congo and and the national authority.

So we were aware the first of of March and we saw the major also reporting about the 14 death.

So this happened near the border with Angola and the people affected, really elder people.

And investigation from national side, you know, highlighted that was due to COVID likely because, you know, if you look at the symptoms and everything, and the age group is largely due to COVID-19.

So they're still doing investigation, including in PCR in Kinshasa because they couldn't do it.

That we'll continue to follow up to make sure this is due to COVID for our information, but also to be able to prevent further, you know, deaths in that era.

[Other language spoken]

Thank you, Doctor Sosafo.

I would like now to give the floor to Emma Fart from Reuters.

I am giving the floor to as I see them in the in the chat.

Emma Fart, you have the floor.

[Other language spoken]

I was also hoping for more elaboration on the readiness of countries to start vaccination campaigns, and I'm particularly interested in the challenges of having simultaneous outbreaks of Ebola and COVID-19.

Given that both of those diseases require vaccines that need cold chain or ultra cold chain.

Is that proving to be a problem and is it putting a great strain on facilities and resources?

[Other language spoken]

Who wants to take this question?

Michelle, you can take this.

Thank you very much.

In most of these countries we are dealing with quite fragile health system including capacity to address many public health challenges.

So of course, dealing with both COVID and Ebola remain a challenge.

There are some similar approach at least in some of the component like community subsidisation as well as preventive measures that have to be implemented.

Vaccination is maybe less challenging because it's in in different areas.

And I think the approach in most of the countries for COVID, they will probably start with health workers while Ebola targeting contact and contact.

So the target is quite different and it could be at a different location.

But should the outbreak spread in many places, both of them, then this would be a challenge due to the fragile health system that we have in in these countries.

And as the readiness we are working with countries, in many of them they have finalised the regulatory papers to receive vaccine as well as therapeutic trainings going on for vaccinators.

So in many of these countries they will start soon at least to vaccinate the frontline workers because they will start by this population along the borders, mainly in health facilities along the borders of of Guinea.

So they are moving forward.

It was the one of the components in the readiness that was a bit challenging, but W2 is supporting to move forward this component.

Other anything to add maybe Mr Gay Abdul Salam or it's OK.

Yeah, you have the floor.

Just to add that for the readiness, there is 6 neighbouring country to Guinea and we conducted a self-assessment of readiness.

2 of the countries are not ready and one country is on the borderline and there is 3 countries that are more, less ready.

But when you say ready or unread, it depends on the pillar and of the response where you are talking about.

And particularly as Michelle have already said that one of the pillar which is the vaccination, none of the country was completely ready.

But like the pillar, like the rapid response, all the country has a rough response team and also all of them need some improvement in terms of contact tracing and also in terms of laboratory for some countries.

Over to you.

[Other language spoken]

I think I'll take the last two questions from Peter Kinney, Anadulu Agency and then Lisa Schlein.

Peter, over to you, thank you.

I'm actually not asking this question for Anadulu.

I work for Southern African Media as well.

OK, freelance.

[Other language spoken]

I would just like to know that at this stage of the development of the Ebola situation in West Africa in the last crisis between 2013 and 2016, there was this kind of aura of global panic about the situation.

Is is the situation, the fact that we have with coronavirus blocking out awareness about this Ebola situation or?

Because of the tools that you have now available to you, such as available ability of vaccines and and ring vaccination, is that just enabling you to get on with the job and Doctor Sothe, you have the floor.

[Other language spoken]

This is a very, very important question.

I think, you know, clearly COVID-19 are collecting more attention is normal.

It's a pandemic, all countries are affected and this is going to be affecting the visibility and advocacy for Ebola.

I was giving the example of vaccine by talking about billions of doses for COVID-19, while for Ebola we are still talking about 100,000 of doses.

This need to change.

We need to really maintain **** level advocacy because after COVID-19, we have all the emergencies, we might have another pandemic.

So it's important not only to focus COVID-19, but to make sure that we have the tools on everything we need at global level to address any emerging disease on any dangerous pathogen.

So we need to do more for Ebola.

We need to advocate for for more vaccine.

Clearly we have improved the way we manage Ebola by improving our strategy including the reinvestination, including the trap ticks.

That's why we can't really reduce very clearly the case fatality there.

But it's still a very dangerous disease happening in very weak health system with very vulnerable population.

We need to continue investing in Ebola and all viral hemorrhagic fevers.

Otherwise, it will be just like a neglecting disease.

[Other language spoken]

I would like now to give the floor maybe to the last journalist, Lisa Schlein from Voice of America.

Lisa, you have the floor.

[Other language spoken]

You've answered some of them.

I guess more or less because I'm last, I'm repeating things, but I would like to know if you could delineate the major obstacles as you see them to these epidemics.

Where is it money?

Is it having to deal with twin pandemics, Ebola and COVID?

And the community resistance issue keeps coming up, whether lessons have been learned, particularly in West Africa where you had the historic pandemic there, or whether the the same kind of fears and misinformation that existed at that time is a concern whether that would continue.

And then do you have any outlook in terms of the duration of the epidemics?

I believe that when the last Ebola epidemic broke out in Equatoria, it it was predicted was going to be a walk in the park that was going to be very quick because you have the vaccines and you got all the experience and all this sort of stuff.

So I'm wondering whether I know you're hopeful it'll happen first, but realistically, what is your assessment?

And then lastly, sorry about this.

What measures actually are being taken by neighbouring countries to protect them from getting, well, Ebola, since we're talking about Ebola here?

[Other language spoken]

Dr Sosaif Paul, thank you for that.

[Other language spoken]

I'm sure colleagues will compliment because they have so many friends together, you know, talking about challenges, you know, there's a lesson learned because I've been dealing with hundreds of outbreaks of over the year.

And what I'm saying is not only for Africa, the most important thing, you know, maybe two or three.

First, national leadership is critical.

We have seen in COVID-19 even in developed countries, you know, how they couldn't take the right decision on time.

And this has implication in the capacity to control any outbreak.

And my number 2 is really community engagement, the way you engage community and Community Trust, because if you have a certain level of mistress or distress between the community and the political leader before an outbreak or pandemic, you'll be very difficult to restore that trust and reserve community upfront.

You cannot control any outbreak.

And so we have, of course, some critical challenges in the health system capacity to prevent, to detect and to respond to to large care outbreaks.

This is something you need to face when you don't have a crisis.

If you start fixing your system when you're already in a crisis, it will always take time to put the system in place.

And when we talk about capacity, it's not just about static capacity.

You need to have the mechanism processes to really, you know, trigger the response when you have a crisis.

And we have some advantages in the African region because we have community based surveillance that allow us to work towards the risk community.

And we also have experience of contact tracing, contact identification.

It was very challenging for developed countries during COVID-19.

We have to tell them from Skype how to organise contact tracing, how to really decentralise the operation.

These are some advantages you have in the African region.

But of course, we have the challenges linked to the the weaknesses of the health system and but in terms of prediction, nobody can tell exactly why this level.

Every outbreak is unique and we need to work very closely based on key performance indicator to be able to adjust to adapt the response on a daily basis almost.

[Other language spoken]

Mr Gay, you have the floor for the last time because we need to stop here.

There is another press conference starting very soon.

Abdul Salem, you have the floor.

Thank you very much.

I just wanted to say a couple of words.

I'm working in the outbreak often need to be humble and anytime you think that it is over, it may start again.

But the country here in Guinea have taken an engagement to finish the infection by the end of April, which is possible, but it's going to need an increase in the improvement of all the pillar that where we are working.

Another question or so was related is what is being done for the neighbouring country in order to prevent to prevent the expansion of the outbreak.

Actually, when the outbreak was declared by the government of Guinea, that issue worked with each of the six neighbouring country to make a self-assessment about readiness.

And for the point to where they have weakness, we are supporting them.

For example, for the vaccine, we are working on trying to vaccinate the healthcare workers with the Johnson and Johnson vaccine.

You should know that the Johnson and Johnson vaccine is the 2 dosage vaccine where it is a little bit difficult to use it in the community level to stop the outbreak.

But it is possible to use it for healthcare workers in neighbouring country.

And also we are working with neighbouring country to do some refresher training in some important area like infection prevention and control like also for the treatment and also for the detection of new cases.

So we are working with them and there is a budget and the plan that are developed at each of those neighbouring country.

And we are started with providing a limited amount of money around 150 and $100,000 for each of them to start the responses.

And evidently it is not enough, but we are working with different partner to make sure and the government to make sure that all those activities that are identified are very important are conducted over to you.

[Other language spoken]

Thank you all for your participation.

[Other language spoken]

And thank you, journalists, for always being present for our press conferences.

[Other language spoken]

And the press conference is now over.

Thank you, Eunice, for your support to arrange this press conference.

[Other language spoken]