Now on bbc news, hardtalk with shaun ley, and he speaks to who advisor david heymann. Hello and welcome to hardtalk, im shaun ley. Get ready is the message from the Health Experts fighting the coronavirus, covid 19. 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 Infectious Disease epidemiology at the London School of hygiene and tropical medicine. Hes among those advising the World Health Organization on its response to the coronavirus. Is the organisation moving quickly enough or are powerful countries are slowing the whos response this time . 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 lock down the virus in small outbreaks or to begin strategies that would be in place should it begin to spread wider in the community. In what way do you think this word is unhelpful . Because a lot of people have regarded this as simply a way defining the worldwide spread of this disease, making the point it is simultaneously in different places, and that that can kind of 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. But they did wait until the 30th of january to do it. They waited. Do you think perhaps it should have been a bit sooner . They waited until they have the evidence they felt was necessary to make the recommendation, but now its looking like its 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, thinks a pandemic is now likely and anne schuchat, speaking in the last few days, said its not a question of if, its a question of when and how many people will be infected. So some in what one might call the Public Health industry find the word of value because it helps them identify the scale of the challenge they face. Thats right, and when you think of when the pandemic of influenza was announced in 2009, it changed nothing. The response was the same. Countries have preparedness plans, they put those plans into operation and right now, the word pandemic could actually mean that countries stop trying to lock down the virus in outbreaks and prevent a rapid spread into the country if its so destined to do that. So the word pandemic may have connotations that actually backfire. So is it fair to say this has been discussed by the World Health Organization . Its not that they havent looked at it, theyve actually 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 that countries should use in deciding how to deal with this virus. But this is a question a bit more than the making sure, i heard exactly the sort of 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, whos a former British International development secretary, said until the Global Pandemic is declared, you cant release the World Bank Funds so that poorer countries can actually put the processes in place to be able to deal with the spread of this virus. So this decision could actually impede the response in some parts of the world. It could. But the committee i chair is actually a committee that works closely with the Pandemic 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, forget the word, its not what matters, what matters is whats happening on the ground. Well, thats not ourjob to do. What we do is make recommendations. What would the recommendation be . The recommendation would be to clarify what the difference is between a Public Health emergency and a pandemic and when funds should be released. See, 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 that those funds are released. So this is a live issue at the moment. You spent the first 12 years of your career as a medical epidemiologist in some of the poorest countries in the world. India, then countries in sub Saharan Africa cameroon, cote divoire, malawi and what is now the drc. Surely they need this help now if theyre going to be in a position to protect their populations from this potential spread of this very serious illness . Well, 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 detect and respond and prevent International Spread. Detection this is a really important point. At the end of january, youll know this better than i do, i was generally taken aback by something the World Health Organization 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 Pasteur 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 youve got it, you dont know 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 that showed 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 Center for Disease Control and the who Regional 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 virologists who are working at sites of outbreak and others to understand whats necessary to treat patients, what the best success treatments is. Epidemiologists 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. There is many things understood but whats not yet understood is the transmissibility how easily will this virus transmit in the community. And that must raise concerns for you and other experts about whether the advice thus far, which has been to isolate for two weeks, is actually effective. Weve seen a number of incidents, the most obvious one was the diamond princess, the cruise ship offjapan, where the timescale implied is that this disease may actually be active for much longer than two. 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 might be transmissible just before symptoms begin. Not when youre asymptomatic but just 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 her fever but permitted her to spread anyway the infection. 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 go sooner, but that is 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. Well, certainly the response that china has done is within their capacity to do. Its been a whole government reaction to this virus. By stopping flights going out of the area where the outbreak epicentre is, actually they delayed the arrival of cases in other countries. So thats been shown through epidemiological modelling to be effective. So theyve done other things that have also permitted the rest of the world to get ready should this. Theyve helped us buy time . Theyve helped us buy time. What about the World Health Organization . Some may say too cautious, too political, i say that not with a capital p but with a small p. General, the secretary general, mr ghebreyesus, is former Health Minister in ethiopia. Its not unusual for politicians to end up doing thisjob, and hes obviously got a medical background as well. 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, of 194 member states. So it is a political organisation. Theres a Technical Response category within who, and that Technical Response capacity has been moving forward steadily since the beginning of the outbreak has been announced. In 2003, working at the World Health Organization, you lead the response to sars. Is it of the same family as covid i9 broadly . Its a similar sort of respiratory infection . Absolutely, its the same type of virus. However, the sars coronavirus, from understanding about the virus, is low in the respiratory system. This coronavirus, covid i9, is high in the respiratory system. Greater risk it could be transmit by droplets. Physically higher is what you mean . Yes, and also spreading more easily with a cough or sneeze. There we had this sars outbreak which effectively affected about 8,000 plus people, led to over 750 deaths. We are already up to 80,000 people infected, we believe, as far as its possible to know, thankfully nothing like the same scale of fatalities but still significant numbers of deaths. Yet the contrast between the who response then and now is striking. I was reading an article you wrote back in 2013, reflecting on the events of ten years before, where you talked of a case of a doctor whod been treating patients with this mystery illness taken ill on a flight home and as you wrote, within two hours we were urgently reassessing the evidence. Later that same morning we presented a summary to the director general, then director general of the who, Gro Harlem Brundtland. Quickly comprehending the urgency, brundtland that morning issued an unambiguous call for Health Authorities worldwide to Work Together to stop the disease in its tracks. I say again, has the response this time not been a bit too solid, a bit 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 then that 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 to 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. Not everyone is impressed by the work of the World Health Organization. The United States government is planning to cut its funding by 53 . What would be the impact of that . Well, that means theyre planning to decrease their external funding, which is outside the normal assessed contribution that the who gives. So they will decrease their funding according to whats been said. That will certainly have an impact on the programmes that the World Health Organization supports, but usually they support individual programmes and not generic activities within the organisation. So youre not that worried by that decision . Im very worried. I think that 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 a response such as is going on now with the sars outbreak the coronavirus outbreak. Even president trump, though, seems to think that this is a problem thats going to go away because the weathers going to get warmer as spring arrives and that will solve the problem for us. I 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, then 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 they had the evidence. There are Less Charitable views of what the chinese did and rory stewart, the former International Development secretary for the uk government, 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 some people believe this and are promulgating this idea. I dont say it is right or 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 if possible. Isnt the problem that the type of approach that says lets not offend the chinese, we want them to accommodate, we were here before with sars 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, less 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 misjudgements. I look at it in a more positive manner. In 2003 during the sars outbreak it was not until the director general, Gro Harlem Brundtland, 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. You wrote brundtland spoke openly about chinas reluctance to publicly discuss the duration