Jessica Mouzo, 9 November 2021
Hans Kluge, WHO regional director for Europe, this Tuesday in Barcelona. – MASSIMILIANO MINOCRI
“I am concerned about the pandemic in Europe. By February 1 another half a million people could die ”. The regional director of the WHO warns of an “infodemic” of fake news about vaccines.
Europe is once again the focus of the covid pandemic and the World Health Organization (WHO) does not hide its concern. Social restrictions have been relaxed in some countries and the rate of vaccination has much room for improvement, admits WHO’s regional director for Europe, Hans Kluge (Roeselare, Belgium, 52 years old).
On a visit to Barcelona this Tuesday to participate in the World Hospital Congress, organized by the Catalan employers’ association La Unió, the Belgian doctor gives Spain and its high vaccination coverage (around 80%) as an example, but believes that you cannot lower one’s guard.. Neither in Spain. The pandemic is not over.
Question. In just four weeks, covid cases in Europe have grown by 55%. Why is this happening?
Answer. There are two main reasons: the first is that in most European countries vaccination has been stabilizing rather than growing and, secondly, there are several countries that are relaxing public health measures and social restrictions in a moment in which the cases increase. On the first, the issue is no longer access, but skepticism towards vaccines, which is why I will create a European working group on people who do not want to be vaccinated. And we have to be more proactive to face fake news. Regarding public health measures, it is necessary to better explain to people that they are not an attack on anyone’s freedom. The preventive measures that governments are applying are precisely to avoid strict confinement.
Q. Are you concerned about the pandemic situation in Europe?
A. Yes I am worried, without a doubt. We are working with the Institute for Health Assessments (in Seattle), and a projection was made: by February 1 another half a million people may die in Europe [WHO’s European region consists of 53 countries, including Russia and republics ex-Soviet]. But we know what to do: vaccination, masks and ventilation. And hopefully soon we will have treatments.
Q. Vaccination coverage in Romania is 30%; in Bulgaria, 22%. In Spain, on the other hand, almost 80%. Are there two Europes?
A. There are 53. I created a unit on behavioral studies and we did a study to understand what the perception of people is that they do not want to be vaccinated, and in each country it was different. Many policies are based on assumptions, but we need data and, from it, design a strategy according to each community. Not a national strategy, but by community.
Q. Do people no longer trust their politicians or health authorities?
A. In many countries it is a problem, without a doubt. Let’s say that in countries where politicians listen to scientists, as in Spain, the situation is better. But there are several countries where politicians adopt popular measures or under pressure from the opposition. At this moment in history, we need the unity of all political parties because there is only one way out of the pandemic: politicians with scientists and with the people to move in the same direction.
The third dose is not a luxury, it is part of the vaccination standard because immunity lowers “
Q. What is the power of anti-vaccine groups in Europe?
A. Anti-vaccines are a challenge, but in many countries [vaccination skepticism] is due to misinformation. We have the pandemic, and then an infodemic. Even well-educated people sometimes believe this [hoaxes]. We don’t have to spend a lot of time on those on the hard wing because we are not going to make them change their minds, but those may be 1% or 2% of the population. You have to focus on the rest to convey appropriate information in a way that people understand. Vaccines save lives.
Q. How is this new wave resolved in Europe?
R. We are going to launch a communication campaign at the European level with influential personalities, country by country, with three messages: first, vaccines save lives; second, please wear the mask, especially indoors, and where social distance cannot be guaranteed; the third message is ventilation, because it is not talked about enough. And as soon as the European Medicines Agency approves the treatment, we will influence it. Because even with the vaccine we are a little behind, and if a drug were available that would reduce mortality by 50%, it would be a great advance.
Q. What is the influence of the variants? The delta plus is not yet considered of concern.
A. Not yet. But the more transmission, the more mutations. That is why we need everyone to get vaccinated and we need treatments. Because if we have a super plus delta where the vaccine is less effective, we will need, above all, treatments. But do not spread panic. WHO sees 100 mutations every day and most are not a cause for concern and vaccines work.
Q. Is it pertinent to promote the third dose in rich countries when there are poor countries without access to the vaccine?
A. There is a misunderstanding here: the third dose is not a luxury, it is part of the vaccination standard because immunity is decreasing. And if we do not do it for the elderly now, we will have deaths again among this group. You have to do everything, as in Spain: give the third dose and donate 50 million doses to other countries. If all countries had done the same, it would have been resolved. But there are many States that have surplus vaccines without doing anything, about to expire. We need political commitment and leadership. It is the only way out of the pandemic.
Q. Will the origin of the covid be known?
A. It is very difficult, but countries should share data in a transparent way. At the end of November there is a special session to address a new global treaty on pandemics and one of the key questions for Member States to decide is what power they give to WHO. To this day, I do not have the mandate to go independently to a country and analyze all the data and all the equipment. The WHO is not an international inspection, we are simply there to help the countries and it is the Member States that govern us and those that should give us more capabilities.
Q. The WHO was highly criticized for its investigation into the origin of covid and for the slowness in the first days. What have been the big mistakes and what have they learned?
A. Before detecting the first case in Europe, I already had the team on the ground. From the WHO Europe we could have done better, for sure, and the countries too. But we must tell people that we are in an unprecedented situation and it is normal that we do not have all the answers. We are learning every day. I think this is an important lesson for the WHO because we need to follow the precautionary principle: if one is not sure and can apply a non-harmful measure, such as the mask, it is better to do it before having the evidence. WHO has learned three things. First of all, the role of regional offices has to be greater, they should be trained to call and alert before declaring the pandemic. Another lesson: the legal framework that guides the behavior of the WHO and the countries during the pandemic is called International Health Regulations, but it does not have forecasts to see what happens in the event that some Member States do not comply with it, and this would have to tackle it. Third, there was an independent panel that looked at WHO’s performance and clearly said it was underfunded. We need more flexible and sustainable financing.
Q. What do you expect from the other respiratory viruses this winter?
A. There will be many more because last year there were many less due to public measures, but this also means that this year there will be less immunity against these viruses. People who can should have both injections [against covid and flu] and health personnel must be protected. I’m very worried. Two out of 10 healthcare professionals are burned [exhausted] and we have a problem. In fact, we agreed with Minister Darias to work together with Spain on the mental health of health personnel.
WHO needs more flexible and sustainable funding ”
Q. What about other diseases, like tuberculosis or HIV?
A. Spain will have the presidency of the EU in 2023 and we will work with Darias and her team on an important political document to reduce stigma and discrimination against HIV, because it is the main obstacle to its elimination in 2030. Next year we have two action plans that we will implement in Europe: one to end tuberculosis and another plan to treat HIV, hepatitis and sexually transmitted infections based on good primary care. This is the main challenge today. With covid we will have many difficulties, but we cannot forget about other diseases, including cancer.
Q. When will the covid pandemic end?
A. I can’t say when it will end, but I can say how it will end: with an equal deployment of vaccines and treatments, safe schools, and booster doses. We must also continue to pressure the virus with preventive measures, such as masks, ventilation, control of cross-border mobility, and we must increase tests, including genomic tests so that new variants can be detected soon. But I am optimistic. Not that next year is over, but we will have passed the acute phase, as long as people in Europe are vaccinated.