Youre pretty much up to date. Its about liz30am. Now on bbc news, hardtalk. Hello and welcome to hardtalk, im shaun ley. Get ready is the message from the Health Experts fighting the coronavirus, covid i9. At least 80,000 people are already infected in more than a0 countries, and that number is expected to rise. My guest today is david heymann, professor of hygiene tropical medicine the london school. Is the World Health Organization moving fast enough . Will the price be paid by those unlucky enough to get sick . Professor david heymann, welcome to hardtalk. Do you think it is on the point of becoming a pandemic . The word pandemic is really a distracting word because it means Different Things to different people. What needs to be done is countries need to do their own Risk Assessment and decide what they can do best, whether its to lockdown the virus in small outbreaks or to begin strategies that would be in place should it again to spread wider in the community. In what way do you think this word is unhelpful . A lot of people have regarded this as simplya a lot of people have regarded this as simply a way to define the worldwide spread of this disease, making the point it is simultaneously in different places, and that can help trigger an international response. Theres several reasons. First of all, the who uses the Term Public Health emergency of international concern, and theyve already called this an emergency of international concern. They did wait until the 30th of january to do it, dont you think it should have been a bit sooner . They waited until they have the evidence they felt necessary to make the recommendation, but now its looking like it is spreading, in outbreaks at least, worldwide, and possibly could spread into the communities, there wont be a change with whats going on now if the word pandemic is used. The us centers for Disease Control and prevention, where you once worked for many years, say pandemic is likely and ansu fati, speaking in the last few days, said it isnt a question of if but when. Some people in the Public Health industry find the word of value because it helps them identify the scale of the challenge. Thats right, and when you think of when the pandemic influenza was announced in 2009, it changed nothing. The response was the same. Countries have preparedness plans and they put those plans into operation and right now the word pandemic means countries could stop trying to lockdown the virus without outbreaks and prevent a rapid spread in the country if it is so destined to do that. The word pandemic may have connotations that could actually backfire. Is it fair to say this has been discussed by the World Health Organization . Its not that they havent looked at it, theyve engaged and considered whether it would be useful and theyve effectively said no, its no use. Thats not exactly the case. Yesterday there was a discussion at an Advisory Group i chair, we talked about the usefulness of declaring a pandemic and we asked for the criteria that would be used to announce that pandemic. But at the same time we talked about possible confusion between the Public Health emergency, thats already been announced, and also about the strategies countries should use in deciding how to deal with this. But this is a question a bit more than making sure, i heard exactly the argument youre making by another Public Health expert on the radio in the last few days, because it does have a direct impact. Rory stewart, who is a former British International developers and secretary, before until. And this decision could actually impede the response in some parts of the world. It could. The committee i chair is actually a committee that works closely with the damning Emergency Fund at the world bank and we are working to make sure that funding is made available when its needed, and now its needed in many developing countries. So youre saying to the World Bank Must get the word, its not what matters. Ourjob is to make recommendations. The recommendation would be to clarify what the difference is between a Public Health emergency and a pandemic and when funds should be released. That takes us back to the same problem, doesnt it . If they still need to clarify that and the word isnt being used, the funds are not being released. Its absolutely right and were working to sure these funds are released. This is a live issue at the moment. You spent the first 12 months, years of your career as a medical epidemiologist. Surely they need this help now if theyre going to be ina this help now if theyre going to be in a position to protect their populations from this potential spread of this very serious illness stop the actually they needed the funds in advance. Right. Thats the whole problem with International Development aid and the pandemic Emergency Fund. Funding should be made available to countries, governments should be committed in those countries to use those funds to develop the capacities they need to develop the capacities they need to detect and respond and prevent International Spread. Detection, this is a really important point, at the end of january, this is a really important point, at the end ofjanuary, youll this is a really important point, at the end of january, youll know this better than i do, im generally taken aback by what the who said in a radio interview, in sub Saharan Africa there were two countries in the whole of the continent that could test for this. Senegal at the Pastor Institute and south africa. Thats an illustration, isnt it, about how essential it is the money is made available quickly because if you cant test for it, you dont know if you got it and if you dont know if you got it and if you dont know youve got it, you dont know how far its know youve got it, you dont know how far its spread, and if you dont know how far its how far its spread, and if you dont know how far its spread, you got no chance of containing it. Absolutely, and yesterday we showed a map where every country in sub Saharan Africa a map where every country in sub sa ha ran africa has a map where every country in sub Saharan Africa has had training and established a centre where they can do the analysis of the nucleic acids to better understand whats going on. So there has been Funds Available and those funds have been used to strengthen capacities through the Africa Centre for Disease Control and the who Regional Office in africa. What do you think office in africa. What do you think of the World Health Organizations response thus far . I think its been a very solid response from the beginning, and what the who is doing is networking epidemiologists, clinicians and virology s who are working at sites of outbreak and others to understand whats necessary to treat patients, what the best success treatments is stop the best success treatments is stop the epidemiologist working together have understood how the disease is spread from person to person, close social contact and Health Worker infections, and it also understands the sequence of infection versus disease virologists. There is many things understood but watson not yet understood is the transmissibility, how easily will this virus transmit in the community . Whats not understood. That must raise concerns about the advice thus far, which is to isolate for two weeks, is actually effective. Weve seen a number of insta nces, effective. Weve seen a number of instances, the most obvious one was the diamond princess, the cruise ship, offjapan, the diamond princess, the cruise ship, off japan, where the diamond princess, the cruise ship, offjapan, where the timescale implied is that this disease may actually be active for much longer diamond princess. Actually be active for much longer diamond princess. Thats right, its still not clear what the maximum period of intubation is for this virus and thats very important to understand. And also theres a lot of information out there that suggests that the virus may be transmissible just before symptoms begin, not when youre asymptomatic but just as youre begin, not when youre asymptomatic butjust as youre developing symptoms. Theres been evidence of that in germany, for example, when a woman who was developing symptoms took a medication which decreased herfever took a medication which decreased her fever but permitted her to spread the infection anyway. Her fever but permitted her to spread the infection anywaylj her fever but permitted her to spread the infection anyway. I go back to this question of the speed of response, because its very striking. Weve talked about this emerging some time in december in china. Its the end of january before this global emergency is declared by the World Health Organization, there was pressure to do so sooner, but thats whats happened. There are those who think this solid response, to use your word, is actually a cautious response which may be fine but given the way things are developing, may not actually be adequate. Certainly the response that china has done is within their capacity to do. Its been a whole government reaction to this virus. By. Flights going out of the area where the outbreak epicentre actually is, they delayed the arrival of cases in other countries, so thats been shown through epidemiological modelling to have been effective. So theyve done other things that have also permitted the rest of the world to get ready. Theyve helped us by time . Theyve helped us by time. What about the who, some may say to cautious and too political, i say that not with a capital p, a small p, its not unusualfor that not with a capital p, a small p, its not unusual for politicians to end up doing thisjob and the chief medical officer has a medical background as well but i wonder if theres a danger that mitigates against a willingness to be potentially confrontational when it comes to the crunch. This is such a big issue that actually a bit of banging Heads Together might sometimes be necessary. The World Health Organization is a political organisation. Its an organisation made of Member States 194 members states. Theres a Technical Response category within the who and that Technical Response capacity has been moving forward steadily since the beginning of the outbreak has been announced. Into thousand three, working at the withheld, who in 2003, you lead the response to sars. Is it of the same family as covid 19 broadly . Its a similar sort of respiratory infection . Absolutely, its the same type of virus. However, sars. It is low in the respiratory system but this coronavirus, covid 19, is high in the respiratory system. Greater risk it could be trans by droplets. Physically hire is what you mean transmitted. Yes, and also spreading more easily with a cough or sneeze. There we had this sars outbreak which effectively affected about 8000 plus people and led to over 750 death. We are already up to 80,000 people infected, as far as its possible to know, thankfully lusting like the same scale of fatalities but still significant numbers of deaths nothing like. The contrast between the who response and then and now is striking. I was reading and now is striking. I was reading an article you wrote back in 2013 reflecting on the events of ten yea rs before, reflecting on the events of ten years before, where you talked of a case of a doctor treating patients with this mystery illness taken ill ona with this mystery illness taken ill on a flight home and as you wrote, within two hours we were urgently reassessing the evidence and later that same morning we presented a summary to the director general of the who, quickly comprehending the urgency and that morning he issued an unambiguous call for Health Authorities do well together worldwide to stop the disease in its tracks. I say again, has the response this time not been a bit too solid and too cautious . This is a much different situation from what we understand. Sars virus occurred from one or two events from animals to humans, causing an infection, and a few chains of transmission. It became amplified in hospital settings when Health Workers got infected. This outbreak, from what we understand, started explosively with many, many people infected at the same time. Many, many different chains of transmission created. Going into families where the majority of transmission appears to have occurred. Doesnt that mean the response should be appropriately more urgent if youre talking about, as you said, an explosion of infection as opposed to a much more controlled and measured rate of infection . You know, countries report when they want to report and china reported when it felt it had the evidence that it should have two report. Since then theres been quite active participation of china in providing information on a daily basis to the World Health Organization, and also in providing other evidence thats necessary, including permitting a team of International Experts to go in and sort out some of the information with them. What everyone is impressed with. The with them. What everyone is impressed with. The United States government is planning to cut the who funding by 53 . What would be the impact of that . That means theyre planning the impact of that . That means they re planning to the impact of that . That means theyre planning to decrease their external funding, theyre planning to decrease their externalfunding, which theyre planning to decrease their external funding, which is theyre planning to decrease their externalfunding, which is outside the normal ss contribution that the who gives. They will decrease their funding according to whats been said. That will certainly have an impact on the programmes that the World Health Organisation support, but usually they support individual programmes and not generic activities within the organisation World Health Organization. Activities within the organisation World Health Organization. So youre not that worried by that decision . Im very worried, every country should continue to contribute to their maximum possibility to the World Health Organization, which is the only agency that can help us co ordinate agency that can help us co ordinate a response such as is going on now with the sars outbreak. The coronavirus outbreak. Even President Trump, though, seems to think this isa trump, though, seems to think this is a problem that is going to go away because the weathers going to get warmer, spring arrives and that will solve the problem for us. Get warmer, spring arrives and that will solve the problem for uslj havent seen that evidence and the virus is transmitting very well in singapore, which is a very tropical and warm climate. So if the evidence can be presented, i will believe it, but until i see the evidence i dont believe whats being said. You mentioned the Chinese Government and mentioned that they presented the evidence when they thought it was the right moment. There are Less Charitable views of what the chinese did and rory stewart says the decision by the World Health Organization to call the global Health Emergency at the end of january and not sooner was purely for political reasons, the desire not to offend the Chinese Government. What do you make of this . I make that to all believe this . I make that to all believe this and are promulgating this idea. I dont say it is wrong, what i say is we need to pull together now and make sure that we do what we can to contain and stop the International Spread of this outbreak is possible. Isnt the problem that the type of prejudices lets not offend the chinese we want them to accommodate, we we re chinese we want them to accommodate, we were here with stars and at the time there were problems. It took a prominent doctor, china, for example failed to notify the who until several months after the virus was discovered, and then it took a prominent doctor in 2003, april of that year, to accuse beijing of covering up. Only then did we start to see accurate reporting of numbers. In other words, the Chinese Government and there may be others of with this is true, unless the Chinese Government is pushed into it, it will not voluntarily provide that information and inadequate statistics mean you make misjudgments. I look at it in a more positive manner. In 2003 during the sars outbreak it was not until the director general accused china publicly of not providing information that information began to flow. This time that has not been necessary. The information has flowed and the information continues to flow with the team that just got back yesterday and spoke about the knowledge that they have gained from their travel to china. 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