that we have the information we need. have you seen the video of the deputy health minister, the main new york stock market index iraj harirchi, from monday has seen its biggest points drop of this week, standing next to the government spokesperson in history because of fears that on iranian television at a news coronavirus will hit economies conference in which while he was around the world. speaking, the minister is standing next to him sweating profusely, dabbing, constantly dabbing his head with his handkerchief, the dowjones, s&p 500 and nasdaq looking very well. have you seen it? indices all lost more than 4% i have not seen that. it may be worth looking at it, of their value. because in the words of the abc news the international monetary fund says it would be funny if it it is likely to downgrade its global were not so serious. economic forecast the guy on the left was the deputy health minister and we subsequently because of the outbreak. learned he had coronavirus. he was suffering. the government spokesman at least 29 turkish soldiers have is literally saying there is nothing been killed and many more injured, to worry about. that's the problem, beautifully in the syrian province of idlib, summed up by that image. reportedly by government forces. governments that don't want turkey has vowed to retaliate. to frighten or panic their public, and this video is perhaps, as you say, trending on bbc.com. the who did not want to panic taylor swift has transformed herself the public and therefore held back into a man in the video from advertising this crisis and saying it was a global emergency health concern earlier thanjanuary for her latest song — called, simply, the man. 30, but actually, in the meantime she appears to use the song people are getting infected. not only are they infected to air her grievances against some but some have died. parts of the music industry. and that kind of caution, that's all. stay with bbc world news. that kind of politics, be it the who or individual governments, ultimately cost lives. i can't agree more with you on that and this is late in the outbreak and there should be transparency in every country,

about what's going on about and where the outbreaks are occurring. what lessons do you draw from what's happened so far in tackling what's to come? news, it's it's time for hardtalk. what i've learned is that politics hello and welcome to sometimes gets in the way hardtalk, i'm shaun ley. of outbreak containment "get ready" is the message and response. from the health experts fighting but there's always a technical team the coronavirus, covid—19. working and technical areas at least 80,000 people are already in health are a way that the whole infected in more than a0 countries, world can work together and that number is expected to rise. to stop the disease. in 1970, in the 19705, the world worked together. russia, the us everyone my guest today is david heymann, together to stop smallpox professor of infectious disease and eradicate smallpox. epidemiology at the london school despite the political pressure of the time, of hygiene and tropical medicine. despite the geopolitical pressures that were occurring, a public health goal was achieved. he's among those advising the world health organization health is a good way of working together on its response to the coronavirus. to overcome geopolitical differences. what is a prospect of being able to contain this virus, is the organisation moving quickly covid—19, and of being enough or are powerful countries are slowing the who's response this time? and will the price be paid by those able to treat it? unlucky enough to get sick? that depends on several factors theme music and one factor that we do not understand is the transmissibility. the ease of transmission from human to human. once we understand that, predictions can be made and we can

only say from epidemiological modelling that if the reproductive rate, or the possibility of transmissibility is high there will be a widespread community involvement. and right now it is high? professor david heymann, welcome to hardtalk. right now involvement seems to mainly be in very close contacts do you think it is on the point in families and health of becoming a pandemic? workers and others. 82% of cases in china the word "pandemic" is really a distracting word because it means are from close family contact. different things to different people. what needs to be done is countries that is not community need to do their own risk assessment spread, that is household and hospital spread. thank you very much for being and decide what they can do best, whether it's to lock down the virus in small outbreaks or to begin with us on hardtalk. 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. there's several reasons. first of all, the who uses the term

"public health emergency of international concern", and they've already called this an emergency of international concern. but they did wait until the 30th of january to do it. and once again, just as i was they waited... beginning to think about do you think perhaps it should climatological spring, at the end of have been a bit sooner? they waited until they have the week, thursday brought a taste the evidence they felt was necessary of winter to some areas and yet, to make the recommendation, but now it's looking like it's which of the rest of february is spreading, in outbreaks at least, going to be all about some really worldwide, and possibly could spread quite heavy rain, and very strong into the communities, there won't be a change with what's winds, details of course on all of going on now if the word the warnings associated with this "pandemic" is used. weather to be found on the bbc the us centers for disease control weather to be found on the bbc weather website. friday itself and prevention, where you once sta rts weather website. friday itself starts off dry enough across eastern spots, it's a complete contrast of worked for many years, thinks a pandemic is now likely fortu nes and anne schuchat, speaking spots, it's a complete contrast of fortunes towards the west. because in the last few days, here, having had a fairly cool said it's not a question of if, it's a question of when and how many start, with the cloud pushing in people will be infected. so some in what one might call relatively speaking, i think it will the public health industry find hold up the temperatures 5—6d to the word of value because it helps them identify the scale start of the day that you have the cloud and the wind in the rain right of the challenge they face. from the word go, and it is that that's right, and when you think of when the pandemic of influenza regime that winds out across those was announced in 2009, dissections in the east. mainly it changed nothing. the response was the same. countries have preparedness plans, because the movement of that front they put those plans into operation just drag the cloud and rain ever

and right now, the word pandemic further towards the north and east during the course of the day, and an could actually mean that countries increasingly mild if essential in stop trying to lock down the virus southern spots, it stays witty in outbreaks and prevent a rapid spread into the country if it's chilly across much of scotland. and so destined to do that. so the word pandemic may have thatis chilly across much of scotland. and that is not the whole story, because what is driving our weather to the connotations that actually backfire. so is it fair to say this has been course of the weekend isjorge, a discussed by the world health organization? it's not that they haven't looked at it, they've actually engaged and considered whether it would be named storm, throwing a weather useful and they've effectively said, front across many parts of the "no, it's no use." british isles. quite early on across the greater part of england and that's not exactly the case. wales, it lingers in the north of scotland. then another portion of yesterday there was a discussion that weather front just hopes scotland. then another portion of that weather frontjust hopes that this hours long because of rain, wintry of course across the high at an advisory group i chair, ground, across northern britain. so we talked about the usefulness thatis ground, across northern britain. so that is a miserable day, li—6d, of declaring a pandemic and we asked for the criteria that would be used to announce that pandemic. but, at the same time, something of that order. and through we talked about possible confusion between the public health emergency saturday and sunday we are looking that's already been announced and also about the strategies that at gusts of 60—70 miles an hour. countries should use in deciding how to deal with this virus. when i show you the pressure chart, but this is a question a bit more than the making sure, thatis when i show you the pressure chart, that is no great surprise, you can i heard exactly the sort of argument cd squeezing the isobars widely you're making by another public health expert on the radio

in the last few days, across the british isles, notjust a feature for northern scotland. spots because it does in the north could see 70 miles an have a direct impact. hour, further south, it is going to bea hour, further south, it is going to be a blustery day. with some rory stewart, who's a former british international development sunshine, it is not all doom and secretary, said "until the global pandemic is declared, gloom, but the feeling of the day you can't release the world bank will be tempered by the strength of funds so that poorer countries can actually put the processes in place that wind which possessed on sunday to be able to deal with the spread amply because jorge is that wind which possessed on sunday amply becausejorge is very close by of this virus." to the north of scotland. so you may so this decision could actually impede the response in some parts not feel every bit if you are close of the world. it could. to five or six further north where the showers will be wintry. and it isn't until monday that we begin to see the ease in the winds and there closely with the pandemic emergency fund at the world bank and we are working will be some sunshine, if you are to make sure that funding is made showers, and relief after the weekend. keep your eye on the available when it's needed, and now it's needed in many developing countries. forecast. take care, goodbye. so you're saying to the world bank, "forget the word, it's not what matters, what matters is what's happening on the ground." well, that's 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, doesn't it? if they still need to clarify that and the word isn't being used, the funds are not being released. it's absolutely right and we're 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 d'ivoire, malawi and what is now the drc. surely they need this help now if they're 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. that's 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, you'll know this better than i do, i was generally taken aback by something the world health 0rganization 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. that's an illustration, isn't it, about how essential it is the money is made available quickly because if you can't test for it, you don't know if you got it and if you don't know you've got it, you don't know how far it's spread, and if you don't know how far it's 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 what's 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 organization's response thus far? i think it's 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 what's 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 i'm mariko 0i in singapore. but what's not yet understood the headlines: is the transmissibility — how easily will this virus transmit in the community. coronavirus fears hit asian stock markets after wall street has its worst one—day and that must raise concerns points fall ever. for you and other experts and, on the coronavirus front about whether the advice thus far, line, a doctor in wuhan tells which has been to isolate for two the bbc the world can't afford weeks, is actually effective. to underestimate the threat. we've seen a number of incidents, the most obvious one was the diamond princess, in one night, the cruise ship offjapan, where the timescale implied i lost five lives. is that this disease may actually be active for much longer than two. i should warn the rest of the world that you guys should take care. i'm lewis vaughan jones in london. also in the programme: dozens of turkish that's right. soldiers killed in idlib. it's still not clear what the maximum period turkey says it will retaliate against syrian government of intubation is for this forces. virus, and that's very important to understand.

and, in the philippines, we return to the volcanic and also there's a lot of information out there that suggests that the virus might be transmissible just before symptoms begin. not when you're asymptomatic but just as you're developing symptoms. there's 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 it's very striking... we've talked about this emerging some time in december in china. it's the end of january before this global emergency is declared by the world health organization, there was pressure to go sooner, but that is what's 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. it's 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 that's been shown through epidemiological modelling to be effective. so they've done other things that have also permitted the rest of the world to get ready should this... they've helped us buy time? they've 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. it's not unusual for politicians to end up doing thisjob, and he's obviously got a medical background as well. i wonder if there's 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. it's an organisation made of member states,

of 194 member states. so it is a political organisation. there's 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? it's a similar sort of respiratory infection? absolutely, it's 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 it's 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 who'd 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. doesn't that mean then that the response should be appropriately more urgent if you're 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 there's been quite active participation of china in providing information on a daily basis to the world health organization, and also in providing other

evidence that's 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 0rganization. the united states government is planning to cut its funding by 53%. what would be the impact of that? well, that means they're 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 what's 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 you're not that worried by that decision? i'm 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 that's going to go away because the weather's going to get warmer as spring arrives and that will solve the problem for us. i haven't 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 don't believe what's 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 don't 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. isn't the problem that the type of approach that says let's 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 misjudgments. 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 china's reluctance to publicly discuss the duration, scale and evolution of sars within its borders and successfully encouraged chinese officials to air the details ane to work with the rest of the world to stop the outbreak. so in that sense, she did that, and had that desirable effect. your argument appears to be that china is already acted voluntarily. really? i think china did act voluntarily. nobody forced them to report this and nobody knew about the outbreak outside of china and china did report it. why they reported, i can't say, why they did not report it sooner, i do not know. the young doctor who died who was one of those who did try to report it, he found himself effectively told to sign a letter — li wenliang — a letter to colleagues

in december that he had found a number of cases, he was summoned to the public security bureau and told to sign a letter accused of making false comments, that it severely disturbed the social order, warned that if he did he would be brought to justice and he wrote underneath, yes, i do understand that. that is not the attitude of a country that wants to share information, is it, about a potentially disastrous worldwide health crisis that is starting in its backyard? at that point in time it seems they were not ready to report it, that is right, and it is a shame because this was an ophthalmologist who also became infected, probably from close contact with a patient, and died. what was lost then, apart from his life and those of others, what was lost by them not acting sooner and sharing symptoms? as an epidemiologist? i cannot look backwards.

all i can say is when these outbreaks occur it is very important to get onto them as soon as you can and understand how they are transmitted and understand the ease with which they may... i take this, i take it back to this point again about what gro harlem brundtland did as director—general of the who did and perhaps that has been absent here, the confrontational approach. not for the sake of confrontation, not for the sake of grandstanding but an argument for saying we are in the middle of such a severe crisis, you have public opinion on your side in terms of mobilising everything this planet can do to try and prevent this turning into a more serious crisis than it already is. isn't that the one time when you can say to those countries, embarrass them, use the bully pulpit, expose them to whatever ignominy is necessary internationally to get them to co—operate? if you pussyfoot with the iranians or the chinese or anyone else, they carry on as they always have and you try to do it when there is not a crisis going on, there is no incentive.

this is the moment, this is the incentive. if the director—general knew that this was occurring and that they had been an outbreak and it was being suppressed than i would have thought that the director—general would actually say we know about this outbreak and we want to learn more. in other words, the who did not know this was happening? i do not know whether they knew or not. have you ever asked the question? no, i have not. because i am interested in today. we have to move forward and get this under control if we can. but from sars, what happens today may provide you with lessons for the next time. i'm sure it will and am sure it will provide many. so perhaps these questions will need to be asked at some point? they may be. it may be useful. in iran, the president has promised transparency on numbers. this is another country facing a significant outbreak but he then told his cabinet colleagues we should not let america mount a new virus on top of coronavirus, and it is called extreme fear. america is also struggling and this gets into politics and gets in the way of actually tackling the problem. politics do get in the way and what is what you need is that

politics have not impeded the technical cooperation going on. i myself spoke with the director of the public health institute in iran yesterday so i know what is going on there. 00:21:11,528 --> 2147483051:47:20,479 their advisory groups know 2147483051:47:20,479 --> 4294966103:13:29,430 what is going on and i am confident