(Transcript) Press Conference – WHO Director General Dr Margaret Chan

Moderator: Good afternoon everybody. I thank you very much for coming to this press briefing, organized so that the director of the WHO, Dr. Margaret Chan, who is sitting here, of course she needs no introduction, who will give you an update on the current situation of MERS on the Republic of South Korea.

Dr. Chan will first give you a brief update and then she will answer questions. She is joined by Dr. Shin Young Soo who is the regional director for the Western Pacific and who will also answer relevant questions.

Before asking your questions we ask you to give your name and your organization. We’ll give you copies of the speech both in English and Korean but at the end of the presentation.

I’ll now ask Dr. Chan to give us her opening remarks.

DG: Good afternoon to all of you, members of the press.
Thank you for all the cameras. I can’t really see you.

Let me suggest one way, take all the photographs you want to take, and then maybe you can stop the flashlight for a moment. Is that okay? Because I can’t see you.

Okay. All right. Thank you. So let me say, good afternoon again. I am here in the Republic of Korea to address a large conference organized by the International Council of Nurses. South Korea, with its national health insurance scheme and universal health coverage of very high quality medical care, is indeed a very attractive place to hold such a prestigious event.

So my commitment to attend was made a long time ago, but I’m happy to be here.

Of course I am well aware that the main reason you are here attending this press briefing is to learn more about how WHO assesses the MERS outbreak in this country.

The WHO with the support of international experts and also the mission that visited this country last week is quickly gaining an understanding of the outbreak and the factors that may have driven it in an unusually rapid spread, manner. 

In addition to international experts of course, I’m truly grateful to the local experts of this country who worked with the WHO mission.

This joint mission between the ROK government and the WHO helped us to understand more about this MERS Co virus and why it is happening, you know, the way it is in South Korea, and I must stress, I must stress, all the new information is reassuring, but that reassurance is qualified. 

As we all know, outbreaks are unpredictable, and MERS most especially so. There is huge gaps in our knowledge about the MERS coronavirus and the disease it causes. 

Scientists are not sure where the virus hides in nature, how it spreads, whether asymptomatic carriers play a role in transmission, or even why some patients die and others recover.

Until we know we have broken the last chain of transmission, we must maintain our vigilance.

The coronavirus that has been, it has been sequenced by both the scientists in this country, and in China, and we have shared the gene sequence of the virus with the best scientists in the world and so that they can analyse whether the genetic sequence of the virus have changed. But the good news is the scientists confirm that there is no genetic changes have been detected.

The joint WHO mission with the Ministry of Health also found no epidemiological evidence of any unique features that suggest new modes of transmission. 

All these are very reassuring news.

The risk of MERS virus to the general public is considered low as long as transmission is occurring in a confined setting, like in a health facility. 

Even if transmission spills over into the general community, such cases are not likely to sustain further transmission. But the government must act on them very quickly to intensify investigation.

This is also the situation we observed in the kingdom of Saudi Arabia, with large hospital-associated outbreaks where some third-generation and fourth-generation cases occurred but there was no consequent, you know, further transmission, and did not affect their overall outbreak.

And as you have heard from the government here, they have admitted that at the beginning of the outbreak, the start and the work was a bit slow. 

And it is also, I should share with you that the first case, the first person that returned after traveling to South Korea also did not know that he himself was sick with MERS virus, and of course he did not share his full travel history.

So the medical doctors and the health system that take care of the index case were not aware of that, and they were also taken by surprise.

And of course we also learned that at the early stage, contact tracing was not as complete as we would like to see it.

And some of these unidentified and unsuspecting contacts went on to spread the disease further in a growing number of hospitals.

And of course you know the names of these hospitals at the early stage were also not shared with the public.

It tells you the importance of timely sharing of information in a transparent manner, starting from you know the patient themselves, also in a very good dialogue with the medical doctors and the system that take care of them, as well as with the public health officials. And this would be important, so that investigations and testing of the suspected cases can be done in a very urgent and timely manner. So it requires cooperation by all parties to make sure that the information flow is smooth. 

Our current assessment of the MERS situation in this country is, the government is now on a very good footing. The response of the health authority has been exemplary. 

You may say that at the beginning, it was a slow start. But that slow start was followed by world-class epidemiological detective work. 

The country’s highly-developed IT capabilities allowed real-time tracking of spread and reporting of findings. 

The response in this country has been strengthened, very quickly, systematically, and very significantly. And I can say, very few other countries in the world can do this.

Going forward, I think implementation of stronger contact tracing, monitoring, and quarantine measures, followed by, and we are already seeing a decline in new cases, suggests that the control measures put in place by the government are taking effect. 

The MERS outbreak in ROK can be stopped, although it may take longer than everyone would like to see. 

I urge friends in the media, and through you, the general public, the community to support the health professionals in this country who have been working tirelessly to control the outbreak. These people are exhausted. We need to support them.

And I would like to conclude by saying that the WHO’s assessment is shared by the Emergency Committee under the international health regulations who met on Tuesday the 16th of June. The MERS outbreak in South Korea does not constitute a public health emergency of international concern.

I believe in the talent and the wisdom of the people in this country. With their support, through the government’s policies, this outbreak would be brought under control.

I am now happy to take your questions.

Moderator: Thank you very much, Dr. Chan. We have two microphones on the floor, and we’ll provide them to you before you ask your questions. As I said before, please give your name and your organization prior to your question.

Reporter: Hello, I’m from Donga Ilbo, a daily newspaper. You mentioned about the DNA sequencing and that there have been no differences that you reported between Saudi Arabia and Korea. However we have seen that in Korea there haven’t been many patients who suffered from kidney failure in the end because of MERS but we have seen that in Saudi Arabia. Why do you think that is? 

DG: You want me to answer the questions one by one or you want me to take a few? 

I don’t know, I just want to give them a chance to ask more questions.

Reporter: Hello I’m from KBS. I have two short questions for you. The first is in Korea our guidelines state that the people who are being traced, the contact persons who are being traced currently, these people are limited to those people who have stayed for one hour in contact within 2 meters of an infected person. Do you think these guidelines are needed and do you think that they are effective and do you think they are sufficient given our current circumstances?
And my second question is that in Korea, there have been cases where one patient would go on to transmit the disease to several dozens of patients. In light of this, do you think this virus would not change its DNA? It would not mutate? 

Moderator: One more question.
Gentleman in blue.

Reporter: I’m from Chosun Ilbo it’s a daily newspaper. I have a question for you Dr. Chan. I understand that as the health minister of Hong Kong you were effective against the fight on Avian flu and SARS. Given your personal experience do you have some advice that you’d like to share with the Korean government?

DG: Thank you for all your questions. Now let me turn to the first one. Well indeed the reason why in a certain country you see certain conditions more than others, this is due to multiple factors. First and foremost, it is very important to know whether the individual himself or herself has any underlying medical conditions. And it is also important for us to know that early treatment, you know, present yourself early during illness, would give you a better chance and better prospect for survival. There are many conditions that drive the outcome of an infection. Now at this point in time, the information from South Korea is not fully captured yet, it is too early to compare the situation in this country with that in the kingdom of Saudi Arabia.

The second question is, you know, thank you for your first question. I’m not sure I remembered, I captured the second one. But let me answer the first question. You talked about the importance of distance and the importance of time, duration of exposure. Actually both factors are important. And also depends on how close you are in the infected person. It may take, if you’re very close to the infected person, it may take less time to get infected, and also whether or not the infected person is, during his cough, for example, is he coughing up a heavy virus load? So basically there are many factors that determine why some people who are exposed get infected and why some people who are exposed, we call them contacts, do not get infected.

Can you help me to repeat your second part of your question? You said in ROK there are many patterns? There are dozens of patterns?

Thank you for that question, and as I said, the virologists convened by the WHO together with other UN agencies, we shared with them the full gene sequence that has been done by the scientists in this country and in China and compared them with the gene sequence of the ones in other countries, and there is no change that will give us reason to believe that the transmission pattern has changed. And you mentioned about why in some cases one individual can spread the disease to few people and in other situations, where an individual can spread the disease to many people. But this is not the first time we see it. We saw that in SARS again. As the colleague in this row said, when I was managing SARS in Hong Kong, we also saw that one person spread the disease to many, many people. Again, that goes back to some of the gaps in science about how disease is being transmitted. And this is an area that we really need to do more to study and understand and compare. As we see now, in South Korea, we are seeing that perhaps a few individuals may spread to more people than others. But don’t forget, at least one of them I know very well, when I look at the details he has been staying in an emergency room for many days and he was quite sick himself. And it is conceivable that in that crowded environment, he could spread the disease to many people in contact with him. Now the third question coming from this colleague is that, yes indeed, I managed the Avian influenza, H5N1 to be more specific, as well as SARS, in my previous job. The lessons we can learn, it is common, and it is common to all new and emerging infections. Number one is always be on alert for unusual disease in a globalized world where people, goods, and services, are moving around the world very quickly. And timely reporting of information and sharing of information with the local community as well as with the international community is important. Because with information, that is good for transparency and that can build confidence. Now, of course, you mentioned about Avian influenza as well as SARS, my experience is that in any outbreak the support of the community is paramount. Without the support of the community, to flow the guidelines recommended by the government, especially the public health measures, it will take longer. It will take longer to control. Now as we are speaking, I have to share with you our experience in West Africa with ebola. And in Liberia, community support, community understanding is very helpful to bring the country to zero case of ebola. And Sierra Leone and Guinea have done tremendous job. They reduced the cases by a large number but still we are seeing community resistance. If the community resists and does not cooperate with the government, the chances of getting to zero takes longer. So I would take this opportunity to urge you and through you appeal to the general public. As I said, Korean people are very smart. I watch all your movies. So please they can get the job done, together with the government here.

Moderator: We will take another set of 3 questions.

Reporter: Good afternoon I’m from Global Briefing. I have two questions for you Dr. Chan. The first is you mentioned SARS and ebola, and it took quite a while to curb those diseases as well. But right now in Korea the sad fact is that many people are dying from the MERS outbreak and this leads us to believe there is no cure for MERS as of yet. So in light of the fact that people are continuously dying every day is there any other method to try to cure or treat this disease other than the fact that we have to cooperate with the government? That is my first question. My second question is, I understand you’re going to be meeting with the Foreign Affairs Minister and the Health Minster of Korea? Can you maybe tell us what you’re going to be discussing with these ministers?

Moderator: We’ll take another question.

Reporter: Thank you.
My question is that we have seen that there are some people who are suggested to stay at home, but still traveling around, even to Jeju Island today. What are your comments about that?

Moderator: One more question.

Reporter: My name is Lee. I have two questions as well. The first is right now, everybody’s foremost priority is how we can solve this situation as soon as possible, so what are your thoughts on how we can solve this, as soon as possible? Another question is that, a lot of people are saying, are criticizing the government that there were some holes in the initial measures taken by the government. And one thing that many people are angry about is that the information regarding Samsung Medical Center, it’s the hospital where a lot of patients were confirmed to have MERS, that information was not given to the public in the initial onset of the disease outbreak. So some people are actually even saying, that there’s a conspiracy going around that maybe there was some sort of collusion between this particular hospital and the government. That is why they did not disclose the information. In light of this, I think the issue of accountability is very important. After this crisis is curbed, someone or some party will have to take accountability for this crisis. What are your thoughts on that? Right now the Korean press is trying to put the blame on one individual in particular, but do you think that is wise? And what do you have to say about this whole accountability issue?

DG: I thought I was going to get three questions, but now it seems everyone asks two questions.

Let me respond to your two points. The first one is yes, at this point in time, MERS, like ebola, we do not have treatment. But we learned from ebola and this would apply to MERS virus as well. Early treatment is very important. If you have fever and cough, please go and see a doctor as early as possible, and try to remember whether you have come into contact with people that have been infected. With that kind of information it’s extremely helpful to the doctor to manage properly. We must remember there are people who suffered from MERS infection and many people survived. Okay? So the chance of survival is always, always better if you come early.

So your second question is yes indeed, I will be meeting by teleconference with the Minister of Health, because he is now devoting full attention to managing the outbreak, and he is in another city, quite far away, I was told it takes 2 hours for me to get there and then come back. So we decided to do it by video conference tomorrow. And today I met with the Minister of Foreign affairs. And of course, our discussion with the Minister of Foreign affairs covered more than just MERS because of his portfolio involved other area of work. But on the MERS co virus, the number one priority for this country is to control the outbreak. That’s the top priority. And of course, after that, and as you are doing the work, what are some of the lessons that the country has learned, and make improvement. But as I have said, after a slow start, the government has put in place one of the strongest response I have seen, so I want to make this point very clear. It’s easy to blame, but then it’s important to recognize when they are doing the right thing.

The second question I get here is you mentioned some contacts, they were still moving around. What to do? Precisely. There are many contacts and the government needs to use multiple channels to do what we call isolation or contact tracing. High risk individuals should be isolated so that they do not spread the disease to other people. For other contacts, they need to follow government’s advice and instruction. And during the period, in confinement or in isolation for these 14 days, don’t move around, but you know, this is a problem. This is a problem. And when individuals do not follow advice and guidelines from the government, it is unfair to blame the government. So that is that. Outbreak after outbreak that I have the privilege to or the unfortunate privilege to manage, without community support and cooperation, it will take much longer to get the outbreak. But I will put it to you, a colleague from the other question, you asked what is the priority? The top priority I’m sure for every Korean in this country is you want to see the outbreak under total control, right? And to do that, the government needs to do her job but the individual citizen must cooperate. And that’s the only way to go. And of course the WHO will continue to work very closely with the government through Dr. Shin’s regional office and through Geneva head office. We have been working already very closely with the government, and we see, our experts see firsthand the total commitment of the government.

And thank you for this colleague, for your question. You have two pieces in your question. The first one is about what is the priority? As I said the priority for this government in the immediate term, in the weeks ahead, do their utmost, continue with the very good public health measures to bring the outbreak under control. That’s the top priority. 

And the second thing is of course they need to learn lessons from some of their slow start, and also from the miscommunication. Being able to give information early and also clearly to the community is extremely important. Transparency is the best policy and it will get rid of a lot of speculation. Now I would not wish to speculate what’s going on but lesson after lesson from all the outbreaks I have managed, timely sharing of information to avoid speculation is the best policy. And that must be one of the lessons learned. Transparency is the foundation for accountability, and so… I think that’s all the questions I have here. But may I make a conclusion? I would like to make three points. Number one, the whole of government approach to tackle the outbreak is tremendous. And the resolve of this government through President Park herself, she cancelled her overseas travel. That is a very strong political commitment to the people of this country. 

Second point is I am very confident that the government has the capability and the people in this country have the wisdom to work together to bring this outbreak under control. 

And the third point is, the WHO together with our partners will continue to support the government’s effort in bringing this outbreak under control and to continue to do studies to understand the virus and perhaps to work together in the areas of research and development for new treatment. 

And let me now introduce Dr. Shin Young Soo who is the regional director. He is from this country and he is the regional director of the WHO.

Dr. Shin: Thank you, thank you Dr. Margaret Chan. These are all questions, for the DG. I’d like to introduce myself and I’d like to say a few words. Maybe I’d like to speak on my mother tongue.

Thank you very much. All the questions were directed to you. Dr. Chan, so I didn’t get the chance to speak but I would like to give some brief remarks. I understand this is a difficult time for the Korean people. And as part of the, as regional director of the WHO which is responsible for the progress of the health and welfare of 37 countries, I can confidently tell you that we also believe, that I also believe as Dr. Chan said that Korea can solve this crisis as quickly as they can and that is because as Dr. Chan has said the Korean government and the Ministry of Health and all relevant authorities are sparing no efforts in undertaking every measure necessary to solve this crisis and this is something that we cannot see in any other advanced country in the world. It is at a world class level. Obviously this is a new outbreak so there are some unpredictable elements to the MERS outbreak but I believe it can be solved soon. And I also would like to say that there have been some advantages that have been touted about the Korean medical system that everybody thought was good which is the convenience and the ease of access to the hospitals and et cetera, but we have seen through this crisis that this can also be a disadvantage. Some customs such as so-called doctor shopping can work against crises such as this. This is something we must consider complementing and fixing, so that this does not happen in the future. As you know WHO has dispatched a team very early on in the crisis to work with the Korean authorities to investigate into this crisis. And I promise as regional director of the West Pacific area which includes Korea, my native country, we will spare no support in giving everything we can to the Korean government to try to resolve this crisis. And once this crisis ends, I believe that it’s imperative for us to gain lessons and implications through proper evaluation and investigation. Through this I hope we can create a stronger healthcare system in Korea.

Moderator: Thank you all for attending. We really appreciate your interest in the work of the WHO and of course your interest in the current outbreak. There are copies of the speech made by Dr. Chan outside. They are both in English and in Korean. Thank you again. That concludes this press briefing. 

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