WHO: What China Must Do Now to Help Fight COVID

Maria Van Kerkhove – WHO

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Marianne O’Hare : Welcome to Conversations on Health Care. This week we
welcome Dr. Maria Van Kerkhove , COVID - 19 Technical Lead at
the World Health Organization on the pandemic ’ s latest
threats.

Dr. Maria Van Kerkhove : We had members of China ’s CDC join our technical advisory
group for virus evolution, where they presented an overview
of what is circulating in the country. They participate in our
technical groups. We've invited them to participate and they
join . W e just need a bit more information fr om them.

Marianne O’Hare : Factcheck .org ’ Lori Robertson checks in and we end with a
bright idea. Now here are your hosts, Mark Masselli and
Margaret Flinter.

Mark Masselli: January 20 is an ominous health anniversary. It's the date of
the first official CO VID case reported in the US. That milestone
was three years ago and all of our lives have been upended
since then . A t the center of the storm is the World Health
Organization. It's a United Nation ’ s agency with a budget of
over eight billion a year.

Margar et Flinter: H ere to give us the latest details is Maria Van Kerkhove , she is
the World Health Organization ’s technical lead for the COVID -
19 response.

Mark Masselli: Welcome back to Conversations .

Dr. Maria Van Kerkhove: Happy New Year. Nice to be here.

Ma rk Masselli: We're glad you're back with us. W e know WHO and others are
tracking over 500 Omicron sub - lineages and that the XBB.1.5 is
the one that's increasing the fastest in our country. Y ou said
it's the most transmissible subvariant th at scientists hav e
detected so far. Can you tell our audience what your current
read on the situation is ?

Dr. Maria Van Kerkhove: The s ubvariant that you mentioned this XBB.1.5 is one of more
than 500 sub - lineages of Omicron that we're tracking . We ,
meaning WHO and the glo bal community , t his subvariant is
actually a recombinant of two BA.2 sub - lineages . Y ou would
have heard of XBB, which caused some outbreaks in a few
countries around the world. T his is a further evolved variant of
that one . It is detected in about 38 count ries. But so far there
are around 5000 sequences that are available globally. Most of
the sequences are available from the US. There are some
estimates of how much XBB.1.5 is circulating in the US.

Maria Van Kerkhove – WHO

US CDC has revised their estimates recently actually
downw ard. It was around 40.5%. A few weeks ago, it went
down to 27%. H owever, in the northeast part of the U.S. , it's
more than 70% of the sequences there. W e have very little
data to assess this s ub variant , but all of these variants we look
at several things . One is transmissibility, and this subvariant
has a growth advantage. W e look at transmissibility by growth
advantage. This one has mutations in it that allow the virus to
adhere to the cell and replicate very efficiently. But it also has
properties of immu ne escape, which is similar to X BB , which is
similar to all of the Omicron subvariants .

We do not have any data on severity yet a nd we don't -- we
can't say if it's more or less severe compared to the other
Omicron subvariants , but we don't have an indica tion that it's
more severe . I t doesn't have any of the mutations that are
known to confer more severe disease. W e recently published a
risk assessment online , but I just want to put this in context.
This is one of many sub - lineages that are circulating. I think the
world is really kind of fascinated by each of these sub - lineages
that are reported and detected. But for everyone that's out
there w hat is important that they need to know is that all of
these sub - lineages behave very similarly. They're incredibl y
transmissible. They have properties of immune escape, which
means you will get reinfected.

We're in the fourth year of this pandemic, which I can't believe
I'm even say ing . P eople have been infected. They've been
vaccinated, but there's been a certain a mount of time from
their last boost. I mmunity over time wanes for infection , stays
pretty robust for severe disease, but people will get
reinfected. But our vaccines continue to work. W hat is
important for the viewer out there is especially if you're in an
at - risk group, make sure you're vaccinated . When was your
last dose ? Because it really matters, particularly if you're in a
vulnerable group to get that boost four to six months after
you've had your last dose. I t's still out there.

I mean, to me, this ju st illustrates once again that the virus
continues to evolve. It is not settled into a predictable pattern.
We as a global community and scientists around the world
need to remain vigilant to track and assess these. But
everyone that's out there really jus t needs to know, what do I
need to do to keep me and my family safe?

Margaret Flinter: Well , Dr. Van Kerkhove , I want to ask you a little bit about your
thoughts on China's behavior throughout COVID. Of course,
it's been somewhat troubling, but you spent t ime in China

Maria Van Kerkhove – WHO

early in the pandemic to get a good feel for how they were
dealing with the outbreak. N ow they've ended the COVID zero
policy that really characterize d their response. W e're certainly
reading of unofficial death estimates that are astounding.
You've noted that they're not sharing sequencing or data on
their experience . W hat's your assessment of what's really
going on there?

Dr. Maria Van Kerkhove: Y ou're right . I did spend some time there early on in the
pandemic and I was really impressed by t he level of
information , the level of data, the level of analytics that they
are capable of at sub national levels. Right now they're going
through a massive wave of Omicron , lifting of those measures.
This virus as transmissible as it is, is passing throu gh the
population . We are working directly with them . T hey are
sharing information, it's just not enough. It's just not as
detailed as we would like.

We've had several direct calls where we have three levels of
our organization at headquarters r egional o ff ice , country
office directly with our counterparts in China to discuss
transmission dynamics, what's happening ? Has it peaked ? To
show us that epidemiologic analysis to look at the trends .

China is huge, even in terms of climatic zones, but more
importantl y we need detailed information about
hospitalizations around the country, the proportion of patients
requiring ICU . T hey have presented to us their program of
response in terms of clinical care capacity , beds, access to
therapeutics and use of those therap eutics. T hat is reassuring
to us that they are looking at this comprehensively, and really
focusing on their population, increasing vaccination coverage,
targeting boosting at - risk groups , a nd that is encouraging , that
is very helpful. But we really need b etter understanding on the
burden and the hospitalizations. W e need more information
on the sequences.

W e had members of China CDC join our Technical Advisory
Group for Virus Evolution (TAG - VE) last week, where they
presented an overview of what is circula ting in the country.
The challenge for that is , is they have detected known
s ub variants, mainly the BA.5 sub - lineages , but we need those
sequences to be shared publicly b ecause there's a handful of
people around the world that really can loo k at this mutat ion
by mutation a nd they work with us. W e want China to work
with us to really determine within those BA.5.2 sub - lineages
those other BA.5 sub - lineages , is there anything else that is
within t hose sequences that's different . W e need a global

Maria Van Kerkhove – WHO

community to l ook at that.

We’d asked them to share more sequences publicly with
GISAID , the platform like GISAID , and also to work directly with
us to do a full risk assessment as well as to generate what are
known as these phylogenetic trees, to look at the molecular
epidemiology and to see how these viruses differ and how
they diverge within the country , and if there's anything that's
different . T here is more information that needs to be shared.

Communication channels are open, and the dialogue is good.
We just need m ore detail. W e're working directly with them.
They participate in our technical groups . W e have clinical
management calls, we have other types of expert groups, and
we've invited them to participate and they join . W e just need a
bit more information from t hem.

Mark Masselli: Well, I think it's that anxiety that people feel that they're not
getting enough information . I think some of the channels have
resorted to using satellite images of crematoriums and the
large increase that they're seeing there. T hat's led several
countries, including the US to issue testing mandates for
people traveling from China. T here's been a push back to these
measures. We just heard from a former longtime CDC leader,
Dr. Richard Besser that he did not think it would really help
b e cause COVID and the subvariant s are already in this country
a nd they're also around the globe. What's WHO ’ s position?
W hat should countries do ?

Dr. Maria Van Kerkhove: I mean, the virus really is everywhere. W e have millions of
cases that are reported ever y week . B etween 10 and 14,000
people die every week from COVID , t hat doesn't make the
news anymore a nd it's just an astounding number. The
circulation of the different variants, in terms of which ones are
where , it varies t here isn't one specific one that' s dominant
worldwide, but the virus is everywhere. I think the measures
that countries have put in place have put them in place
because they didn't know , because they weren't getting the
information out of China that they would like to see .

We always advis e countries to do , to take a risk assessment ,
risk based approach and to ensure that the measures that they
do put in place are reaching that risk. I think what people need
to do everywhere , w e -- a lot of people are focused on China
right now as they shou ld, because it's so acute right now. But
we as WHO are not getting data from most countries around
the world in terms of what we need to assess the impact of
COVID going forward. We're in a completely different situation
than we were three years ago. We wi ll see cases and we will

Maria Van Kerkhove – WHO

see waves of infection, but the impact , the resulting
hospitalizations and death s has been declining over time.
T hat's fantastic b ecause we have diagnostics , patients are
getting into the clinical care pathway early. We have antivi rals
for early in disease. We have many therapeutics focusing on
severe disease, and we have vaccines.

W hat people need to know is that as they live their lives and
people are living their lives, to do it as safely as possible. Think
a little bit about wha t you're doing every day. Keep that mask
with you , wear a mask when you're with -- around others, and
especially when you're indoors, or you don't know where the
ventilation -- if the ventilation is any good when you're on
public transportation . G et vaccin ated and look out for your
loved ones who are in an at - risk group . M ake sure that they
get the care that they need.

There's so many tools that exist . I mean, of the global
challenges that we face right now COVID has solutions, three,
four years in now we'v e got flu, RSV, Strep A, M pox, Ebola,
cholera, there's so many other things that are happening . W e
have to deal with COVID in the context of everything else. It’s
about calibrating the response going forward. But as
individuals, individuals should be empow ered with the
knowledge about what is around them, what is my risk? What
do I do to go to work a nd to get my kids to school ? B ut not live
life and fear . Know that there's a lot that you could do to keep
you and your kids and your parents and your grandpare nts
safe .

Margaret Flinter: Well, that's so interesting. I was thinking as you said it, I really
have developed my automatic risk assessment a s I opened the
door to a restaurant or to a store with your mask ever at the
ready , so thank you. I do want to go back to this situation in
China a little bit , b ut really, it's a question for the world.
Experts , including our friend and now retired Dr. Fauci have
noted the Chinese vaccines as being less effective than the
w estern developed ones. What role do you think that is
playing in the current problems in China? O f course, it leads to
the question of what more can the world community do?

Dr. Maria Van Kerkhove: I mean, there are many, many safe and effective vaccines that
are used around the world, and some are of -- are more
effective than others. The data that we have seen on the
Chinese vaccines that are being used, and there are several
that are in use right now. T hey're introducing more as we
speak . W hen you boost with them the immunity really
increases. I thi nk it protects against severe disease and death.

Maria Van Kerkhove – WHO

W hat is really critical within the population of China of 1.4
billion people is that everyone over the age of 60, anyone who
is immunocompromised really needs that third and that fourth
dose. T hat's what the y're focused on right now , b ecause that
boost really kicks up that that immunity level .

I think the challenge in China is that because they have had
this dynamic zero, this zero COVID policy, there was no
population level immunity increasing because of inf ection .
Ma ny parts of the world that didn't have access to vaccine
have had immunity increased because of infection, and several
waves of infection. Remember, this is the fifth variant of
concern. We've had many waves over these three years.

The vaccine us e in China was really how that population level
immunity was increasing. Now that's changing. Now they have
more of this hybrid immunity because they've had this massive
wave of Omicron. I f you remember, a year ago, try to think
back when Om icron was first detected and what we saw
around the world . At WHO when we were drawing our epi
curves, we had to recalibrate the scale b ecause at the peak,
we had 23 million cases reported in one week. W e knew that
that was a gross underestimate of what was actually
circ ulating. Now it's around five, six, no sorry, it's around
maybe two to three million reported to us. T hat's in the back
drop of a significant decline in sampling and testing.

T hey're going through what most countries went through
about a year ago, but they didn't have that population level
immunity from infection and/or vaccination. I think that's the
challenge. That's what the focus is now . M ake sure those
vaccines that are in country are targeting the at - risk. W e've
offered and many countries have offered to add additional
mRNA vaccines into their portfolio . I t's a matter of them
willing to accept them and to use them , but the global
community is there to support.

I think we hear a lot about the politics and the fights and the
arguments, but the global sol idarity from public health
professionals , from scientists, I think you know this firsthand ,
doesn't matter who is in power, who is in authority, we're
here for each other. I think that's the real human spirit and the
real solidarity of this, which to me ha s helped get me through
these last three years.

Mark Masselli: I want to pull the thread on two things that you said . O ne , i t’ s
not just China, where you're not getting information, places
like Brazil, even parts of the United States which makes this
forec asting a challenge. Yet on the other hand, you have

Maria Van Kerkhove – WHO

partnerships with scientists in all these countries . I think in
your own words, WHO superpower but tell me i s there a
disconnect between governments and the maybe the private
scientists that you're having a relationship with , o r is
everybody in sync here ?

Dr. Maria Van Kerkhove: I think on a scientific level , on a public health level, I feel that
we are in sync . During this pandemic, we as WHO have had the
opportunity to reach out to so many more technical
disciplines, so many more scientists in countries because
everybody went virtual . Our reach and our listening ability has
really grown. I do think it is a superpower of ours . P eople want
to work with us because they want to contribute, I really
wholeheart edly believe that.

I think there is a challenge between the scientific and public
health world and the political world, because there are
different factors at play . W e come to this looking at it from a
scientific and a public health point of view. But we a lso have
changed our view in saying it's never only a health issue, it's an
economic issue, it's a political issue, you need people that are
in power that will stay in power . Y ou need the economies to
be able to rebound . Y ou need the financing to deal with this .

Most of the financing for COVID was pulled from somewhere
else. N ow governments are saying we don't have the fiscal
space anymore. It's contracting over time. W hat we're trying
to do is work with governments to ensure that the threat
assessment is a ccurate, that it's realistic . We can't just stick
our head in the sand and say no one wants to talk about
COVID s o we're not going to talk about COVID anymore. In
fact, I would love to not talk about COVID. M aybe you can
invite me back sometime when I don' t have to talk about
COVID .

Margaret Flinter: We will .

Dr. Maria Van Kerkhove: We have to deal with this because COVID is here to stay, but
we can manage it. W e have to manage it from a health point
of view in our stronger sustained health systems. We need the
financing to support our workforce and our health systems.
W e need the political backing to be able to say this is a
priority. That's the shift we're in . I think we're in a long, messy
transition. E verybody's just like, okay , wh en are we done with
pan demic , make it endemic, let's move on. But I think this
transition phase of getting to longer term respiratory disease
management will take a little bit more time unfortunately .

Margaret Flinter: The World Health Organization Director General recently

Maria Van Kerkhove – WHO

pred icted 2023 would be the year that COVID would no longer
be deemed a public health emergency or based on what
you're seeing in this first month of the year a re we likely to be
into this for a longer period? I know that's a little bit of crystal
ball gazing versus scientific analysis. But what's your thought?

Dr. Maria Van Kerkhove: It is a big crystal ball a nd it's very difficult to predict. I mean,
the short answer is I don't know. But I think we can end this
emergency everywhere because we have the tools t o do so
they exist . T hey exist at the right supply . W e're just not
utilizing them most effectively around the world. I mean, 30%
of the world still has not received a single vaccine . W e're doing
better at trying to reach the targets of a 100% of our health
workers around the world , a 100% of our at - risk populations,
but we're not there yet.

In every country in the world, including in the US w e're missing
key demographics in terms of that . W e have to deal with
access and reach . W e have to deal with misinform ation and
disinformation, which is absolutely rampant . T rust has been
eroded over time a nd it's so hard won and so easily lost , s o we
have to keep up that dialogue. But I am really hopeful. T his is
the scientific hopeful , this is -- we can do this . No , I r eally
believe it because we have the tools that exist.

If we didn't have a vaccine, I would love to see new inhaled
vaccines that could focus on preventing transmission, that
would be a game changer. We have therapeutics, others need
to be a lot cheaper an d need to be more accessible. But they
cover the full spectrum of disease from the antivirals early on
all the way through corticosteroids , it's possible . T he thing that
scares me the most is the complacency and the sheer fatigue
and trauma we've gone thro ugh , b ecause I think the entire
world has gone through something quite incredible. We have
not even begun to mourn the loss of tens of millions of people.
I think that that's something that we're going to have to deal
with the mental health aspect of this going forward, Long
COVID , of course COVID condition is going to be with us for
some time, we have to focus and research that. But I am
hopeful with that we can do this . W e have to collectively put
our efforts together to do that. T hat's also in the contex t of
war and other crises and other conflicts.

Mark Masselli: Let me just ask a question about trust and treaties, if you will .
O ne, you sort of made the point that it's hard to win people's
trust, easy to lose it, we seem to have lost it. I'd love to know
what your message is to individuals who have basically said I'm
believing all of the other information that's coming out to --

Maria Van Kerkhove – WHO

how do we move them , because what we're doing now hasn't
moved them . T hen the issue of treaties, government to
government , s o ho w governments work with each other . Y ou
all have launched an initiative around treaties, but if you could
talk about both the individual trust and then maybe the trust
that happens amongst governments in terms of laying out a
strategy for moving forward .

D r. Maria Van Kerkhove: I think in the individual trust I think those who are really -- who
don't trust government who don't trust scientists who believe
in the conspiracy, which are incredibly persuasive . I wonder
how many of them will be watching this, be cause I think what
we need to do is reach individuals and listen to individuals in
different types of for um , with different types of channels , with
different types of engagement. We've worked really hard to
work with communities, faith - based leaders, youth leaders,
any leaders in communities, to understand , first and foremost
to understand where it's coming from . I s it the
misunderstanding the vaccines were produced so quickly , s o
perhaps you've skipped some steps. I mean, some of these are
questions that c an be answered. T here are others that are will
be very difficult.

I think this is something we as an organizatio n fighting this
info demic d ealing with misinformation and worse
disinformation is something that we're really going to have to
tackle and come u p with innovative ways to do so going
forward. The treaty to me is a promise , are promises by
governments to each other, to their people , to the world. T o
me, I find it quite inspiring that these discussions are
happening.

I'm not involved in the day - to - da y discussions of those. W e
have some amazingly dedicated people who are and it's
complicated, and I know that . B ut to me, that treaty or a ccord
or whatever it's called is a promise. We owe it to our people,
whether you're a government leader or not to do better the
next time . I t didn't have to be this way. We didn't need to
have this level of death and devastation, but we're dealing
with it and we are doing our best to minimize the impact going
forward.

Margaret Flinter: Well, Dr. Van Kerkhove , thank you for your work and the
World Health Organization for its dedication to promoting
health and public health and keeping the world safe. T hank
you to our audience for being here. You can learn more about
Conversations on Health Care and sign up for our email
upd ates at www.chcradio.com . Dr. Van Kerkhove thank you

Maria Van Kerkhove – WHO

again, so much, and best of luck.

Dr. Maria Van Kerkhove: My pleasure. Thanks for having me and Happy New Year.

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Mark Masselli: At Conversations on Health C are we want our audience to be
truly in the know when it comes to the facts about health care
reform and policy. Lori Robertson is an award winning
journalist and Managing Editor of FactCheck.org, a
nonpartisan, nonprofit consumer advocate for voters that aim
to reduce the level of deception in US p olitics. Lori, what have
you got for us this week?

Lori Robertson: Several European countries have reported a spike of group A
Strep infections , mostly among children, including cases of
rare but deadly bacterial infections. There is no evidence the
increase is being caused by nasal spray flu vaccines as social
media post have baselessly suggested . Flu vaccination may
even indirectly prevent Strep A .

Strep A can cause several diseases such as scarlet fever, strep
throat, or impetigo, but in rare occasions it can get into certain
parts of the body or bloodstream causing a serious disease
called invasive group A strep or iGAS . S everal deaths
associated with iGAS have been reported in children in the UK,
France and Ir eland since September.

In the UK, there were more than 27,000 notifications of scarlet
th th
fever from September 12 to December 18 compared with
about 3000 for the same period in the last comparably high
season. Health authorities have said cases of iGAS re main rare ,
but are also higher than normal. England has reported 94
deaths in all age groups, including 21 deaths in children under
the age of 18. In the US the Centers for Disease Control and
Prevention is examining a potential increase in iGAS among
chil dren as well.

The WHO and the CDC have said the surge is likely associated
with the increase in other respiratory viral infections such as
influenza and RSV. The CDC noted that people with viral
infections are at increased risk for iGAS . B ut people who
opp ose vaccines are pushing a different theory , baselessly
suggesting a link between the spike and deadly strep
infections and nasal spray flu vaccines.

The CDC recommends that everyone six months and older get
a flu vaccine every season. The nasal spray flu vaccine , one of
several options , is approved for healthy people who aren't
pregnant , ages 2 to 49. During the 2019 / 2020 season, the flu

Maria Van Kerkhove – WHO

vaccine prevented more than 100,000 hospitalizations and
6000 deaths associated with the flu.

There is no evidence that the nasal spray flu vaccine causes or
increases susceptibility to strep A. The nasal spray flu vaccine
contains weakened flu viruses that are not able to reproduce
in the lungs. Strep A diseases are caused by bacteria, not
viruses. Instead, being sick with the flu can facilitate the
entrance of bacteria into the body. T hat's my fact check for
this week. I'm Lori Robertson, M anaging Editor of
FactCheck.org.

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Mar ga ret Flinter : FactCheck.org is committed to factual accuracy from the
country's major political players and is a project of the
Annenberg Public Policy Center at the University of
Pennsylvania. If you have a fact that you'd like checked, e- mail
us at www.chcradio.com , we'll have FactCheck.org's Lori
Robe rtson check it out for you here on Conversations on
Health Care.

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Mar garet Flinter : Each week Conversations highlights a bright idea about how to make wellness a part of our communities and everyday lives.
While the world grapples with the global pa ndemic , public
health experts have been simultaneously battling another ongoing health threat. Mosquitoes are considered one of the deadliest animals on earth, leading to hundreds of millions of illnesses and some 2.7 million deaths per year globally. D ise ases such as malaria, dengue fever, and Zika are on the
rise.

Dr. Scott O'Neill: This one mosquito called Aedes aegypti that transmits a range
of different viruses to people. They include viruses like yellow fever, dengue fever, chikungunya, Zika . T he consequences can
be very dire , f rom a loss of life through to crippling social and
economic cost.

Marianne O’Hare: Dr. Scott O'Neill is the Director of the World Mosquito
Program which has developed an innovative approach to
eradicating the threat.

Dr. Scott O 'Neill: I was particularly interested in this bacterium called Wolbachia. This bacteria is present in up to 50% of insects naturally, but not this one mosquito that transmits all these viruses. When we put the bacterium into the mosquito the viruses couldn't grow any longer in the mosquito. W e're
seeding populations of mosquitoes with our own , mosquitoes

Maria Van Kerkhove – WHO

that contain Wolbachia . W e're able to spread the mosquitoes
across very large areas very quickly. Once the mosquitoes ha ve
it , they're protected from being able to transmit viruses. W hen
they a re protected, the humans are protected as well.

Marianne O’Hare: Dr. O'Neill's team released the genetically modified
mosquitoes into a targeted area. T he results showed a
dramatic reduction in human infections .

Dr. Scott O'Neill: In northern Australia , we deployed the Wolbachia over quite
large areas, entire cities, and we've seen essentially a
complete elimination , 96% reduction in Dengue in those cities.
We believe if we can scale this intervention across entire
citi es, we can completely prevent the transmission of diseases
like dengue, chikungunya and Zika.

Marianne O’Hare: The world mosquito program is one of six finalists in the
MacArthur Foundation's 100&Change competition, which
awards a $100 million grant to inn ovative public health
interventions.

Dr. Scott O'Neill: W e're hoping that over the next five years we could bring this
technology to protect 75 to even a 100 million people. W e
would hope within 10 years we could bring this intervention to
500 million peop le .

Marianne O’Hare: The world mosquito program, an effective targeted genetic
engineering approach to eradicating the threat of deadly
mosquito borne pathogens, leading to a dramatic reduction in
harm to public health. Now, that's a bright idea.

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M ark Masselli: I'm Mark Masselli.

Margaret Flinter: And I'm Margaret Flinter.

Mark Masselli: Peace and Health.

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Marianne O’Hare: Conversations on Health Care is recorded in the Knowledge
and Technology Center Studio s in Middleto w n, Connecticut,
and is brought to you by the Community Health Center now
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