Welcome to the United Nations. It's your world.

Secretary-General Ban Ki-moon

Press Conferences

Deputy Secretary-General's Joint Press Conference with Dr. Margaret Chan, the Director-General of the World Health Organization, and Dr. David Nabarro, the UN System Coordinator for Ebola Virus Disease

New York, 2 September 2014

          Spokesman: We are joined by the Deputy Secretary-General Jan Eliasson as well as the Director General of the World Health Organization, Dr. Margaret Chan and Dr. David Nabarro, the UN system coordinator on the fight against Ebola. 

     As many of you will have seen from the open General Assembly briefing just concluded and they briefed the Member States on the situation on Ebola.  I will ask the Deputy Secretary-General to open followed by Dr. Chan and Dr. Nabarro.  Sir, DSG, the floor is yours.

          DSG Jan Eliasson: Thank you very much, Stéphane.  And I hope that you saw the webcast; otherwise, I will just repeat to you that we had an overview over the Ebola situation and the response to the Ebola situation.  And the words that I used was that the current outbreak is critically serious and deeply worrying.  And I also said that this is one of the most serious health challenges we have ever faced in the UN

     I pointed to the fact that this is not only a health crisis; it is also growingly a humanitarian, developmental and security crisis potentially.  So the whole UN System is now mobilized for action, but not only the UN System as such.  We will growingly be dependent on actions taken by Member States.  The capacity that is available in their realm is of great importance.  You may recall the Tsunami of 2004, later you can recall also the Haiti earthquake that we were working very closely with Member States with the capacity to help.  We were also underlining the need for immediate action taken.  We are -- we are playing with the time factor, which is very critical.  And we need to have action very soon; and, therefore, you will hear from Margaret Chan and David Nabarro, very concrete asks, demands, requests that we have to the Member States, which we ask them to convey to their Governments as soon as possible. 

     This is going to be a test of the national capacities of these countries and their health systems are very much strained and so is their infrastructure, but it's also going to be a test of multilateralism; a test of international solidarity for people in dire need right now.  So I will leave it at that and hope that you picked up most of the elements from the webcast, but I will give the floor now to Margaret Chan and if you could expand on my comments.

     Dr. Margaret Chan:  Mr. Deputy Secretary-General, good afternoon to all of you and let me once again just repeat some of the comments I have made for the benefit of those colleagues who have not seen the webcast. 

     WHO together with other partners make an assessment - this is the largest and the most severe and most complex Ebola outbreak ever seen in the nearly 40-year history of the disease.  No one, even outbreak responders with experience dating back to 1976, to 1995, who have managed those outbreaks have ever seen anything like it. 

     Now, as of this week, we have more than 3,500 cases confirmed in Guinea, Sierra Leone and Liberia and more than 1,500 died.  Now, the outbreaks and the way we describe it as they are raising ahead of the control efforts. 

     Now, let me perhaps say a few words about Nigeria.  Nigeria had an important case by a traveler from Liberia, by air.  And the robust efforts in Lagos was seeing results.  And the unfortunate thing is one of those contacts escaped contact tracing and moved to Port Harcourt so there they are crossing and we are reporting three deaths and many more people are under surveillance by the Government together with CDC [US Center for Disease Control and Prevention], MSF [Médecins Sans Frontières], WHO and of course UNICEF [UN Children’s Fund]. 

     Now, Senegal also reported its first case on 29 of August and this is an important case from Guinea and a contact again escaped monitoring and traveled by car to Senegal.  The Government is mounting a robust response supported by partners and we hope that they can quickly bring it under control.

     DRC [Democratic Republic of the Congo] - the outbreak is smaller and the Government is again working with partners to make sure that they can smother that outbreak.  Now, I want to make a difference between the DRC outbreak and those that are happening in West Africa.  They are different outbreaks.  The DRC outbreak we have proven by epidemiological evidence as well as spy scientific analysis of the viruses.  It is different.  It is not what I call spread from West Africa to DRC.  So it is a coincidence happening in DRC. 

     As I have said, Ebola has become a global threat which requires urgent global efforts in solidarity with the affected countries.  The national authorities should take the lead and by coordinating all the actors that can bring to bear to help us to control the outbreak.  And that speaks volume of the need for a well-coordinated mechanism, a platform to bring together partners.  At this point in time at the country office, at the regional level, we have what we call EOC, Emergency Operating Centers, where WHO, together with MSF, CDC., UNICEF, World Food Programme, Red Cross and red Crescent - these are regular members.  But going forward we will bring the assets of many other countries and agencies together, we may need to have a bigger platform so that we can have a coherent and well-coordinated big search going forward.

     Let me make it very clear, this outbreak can and will be controlled.  We know what is needed and we know how to do it.  WHO is coordinating also the scientific community for the first time to look at potential experimental therapies.  And, as you well know, on this Thursday and Friday in Geneva a meeting will be convened by the World Health Organization bringing all the scientists from the world, from US, from Canada and many other countries; but also more than 20 scientists from the African continent to look at all the potential therapies, some vaccines, some medicines.  We need to look at what are some of the things we can do and fast-track in terms of clinical trial and to make sure that before we do any good we want to be doubly sure we are not doing harm.  So we are going to test all these modalities to make sure that their safety profile is satisfactory according to the international community before we move forward and work with the industry in a big way. 

     So let me once again stop here and I'll be happy to answer any questions, you know, afterwards.  But let me turn over to the DSG.

     DSG Jan Eliasson:  And I will turn it over to David immediately. Thank you.

     Dr. David Nabarro: I saw eager hands coming up, so this will be very short.  Colleagues, I was appointed to be the coordinator on this issue on the 12th of August.  I was here in this room on the 19th of August.  On the 21st of August I was in West Africa and I just returned at the end of last week.  I'm glad to be back again. 

     As Dr. Chan has pointed out, this is an unusual challenge for the world and it needs an exceptional response by the world.  There are 12 points to this exceptional response that I'd like to pick out.  Firstly, there is a real need to improve understanding of the issue and to mobilize societies around that better understanding of Ebola disease. 

     Number two, control efforts require care for infected people. 

     Number three, the diagnosis of people who have the disease has to be available, and good and contacts have to be identified. 

     Number four, within the affected countries, basic health services need to be maintained. 

     Number five, there are food shortages emerging in the affected communities and beyond. 

     Number six, it's very hard for people to work to control Ebola if they can't be sure of getting their salaries, incentives that are due to them and the necessary materials for operating and they need help to avoid infection. 

     Number seven, in order to do that they need materials such as protective equipment and they need also the basic requirements for running their treatment unit. 

     Number eight, those who provide services need also to be sure that if they get ill for any reason they can get access to healthcare. 

     Number nine, transport is a real priority.  Motorcycles and flatbed trucks are vitally needed. 

     Number ten, some of the policies that are being applied around travel of people from Liberia, Sierra Leone, Guinea to the rest of the world are not appropriate and need to be remedied. 

     Number 11, we've got to find a way to bring supplies into the region with commercial flights not working properly and that means setting up air bridges. 

     And, Number 12, the affected countries were doing quite well economically in recent years.  This is having a really bad effect on their economies.  And so recovery needs to be supported.

     Different parts of the United Nations System have a role in all of these priorities.  Obviously the World Health Organization is central but UNICEF, the World Food Programme, the World Bank, the African Development Bank, and also the Office for the Coordination of Humanitarian Affairs, UN Development Program and right at the center of the Office of the Deputy Secretary-General and the Secretary-General, together with all parts of our headquarters operators, all have roles to play.  And my job is to coordinate all these different organizations as they scale up significantly over the next few weeks, supporting the World Health Organization, supporting the Governments with the kind of coordination that Dr. Chan just identified as being vital for our task. 

     I look forward to returning again, hopefully in a few weeks, and being able to say to you that that scale up is happening.  And, certainly, within the system we will stop at nothing to get it happening because it's necessary for the future of the affected countries, for the future of Africa, for the future of the world.

        Spokesman:  Thank you very much and we will take your questions.  And if I could ask you to just ask one question per hand because we have a lot of people up, Pam.

        Question:  I'm Pamela Falk from CBS News and on behalf of the UN Correspondent Association, Dr. Chan, Dr. Nabarro and DSG has been very active on this very critical issue.  My question is about the experimental vaccine.  You have gotten some examples or some samples, 800 to 1,000 from Canada.  Who will be tested?  How will it be tested?  And how can you get enough to enough people fast enough in terms of the UN distribution?  Thank you.

     Dr. Margaret Chan: Thank you for that question.  As we are speaking we have two to three potential vaccines.  And, as I said, you know, it is important for the scientific community to come together and look at under this very unprecedented situation what are some of the things that they can -- can be done quickly without compromising the safety of all these modalities.  So, you know, Canada, yes, has invested and developed a vaccine.  We were approached by the Canadian authorities.  They are willing to donate 800 to 1,000 vaccines to us so we will want to look at the safety profile and how to allocate very limited resources and how do we allocate in a fair manner, in an ethically acceptable manner.  So these are the discussion and debate that are ongoing.  And I look forward to the meetings, experts, to provide us advice on the way forward. 

          Spokesman: Thank you.  Yes, ma'am, go ahead.

          Question: Is it me?

          Spokesman: Yes.

          Question: Sorry [inaudible] the Japanese newspaper.  Dr. Chan, you mentioned the word escaped a couple of times and I just wanted to clarify.  When you say escape, did you mean consciously avoiding the screening at travel checkpoints or do you mean slip through these checkpoints with symptoms undetected?  Are there people consciously avoiding the screenings and do you know if this is contributing to the curbing of flights? 

         Dr. Margaret Chan: Contact tracing is an extremely important health measure to reduce the spread or contain the spread.  Now, the first Liberian person moving to Nigeria, that happened before WHO’s emergency committee was convened under the international health regulations to advise countries of the world that they need a coordinated approach to deal with this.  And so that was a situation.  And, in fact, you know, the history we are getting, this person, without giving too much, protecting his personal details, was taking care of the sister who died of Ebola and then, you know, he traveled to Nigeria and that is the story.

     Now, the other case, going through Senegal, this is a young person who, again, was one of those, should be under monitoring for 21 days and often times in these situations people get worried.  They are really scared and let's be clear about that.  And they may want to, you know, seek treatment elsewhere or they may want to go and visit their families before they take the eventuality.  And there are multiple reasons why people who are supposed to be under the monitoring of the authorities seek ways to, you know, go for different reasons beyond -- before the 21 days. 

          Spokesman: Thank you.  And the television, your microphone please. Thank you.  Go ahead.

          Question: I will address my question to Mr. Nabarro in French if he doesn't mind, is that okay?

          Spokesman: Yes.

          Question: [In French]

          Spokesman: The question: the CDC says it's worse, what is your opinion about the CDC assessment and then on the airlines. 

          Dr. David Nabarro: Thank you very much indeed. [In French]

          Spokesman: If you can recap in English because I think they were two very critical questions.  Thank you.

          Dr. David Nabarro: I said that we have, of course, been looking very hard at the figures.  And our colleague, Dr. Thomas Frieden of the Center for Disease Control together with our colleague Dr. Keiji Fukuda from the World Health Organization who is sitting in this room have both studied the epidemiology.  And Dr. Chan explained it very clearly, but I would like to use my own words. 

     The outbreak is advancing ahead of us.  It's accelerating ahead of us and we in our control efforts collectively are falling behind.  And the more we fall behind and the more the outbreak accelerates ahead of us, the harder it is to overtake it and to control it.  And so that's why we are talking now about a major surge in the response and why we want to see that surge in place quickly so that we can get back in line with the outbreak and ahead of it as quickly as possible. 

     And, secondly, I said that we do understand why some airlines have discontinued their flights.  We understand the fear.  But we also believe to the proper application of precautions when people are preparing to board flights, it's possible to avoid risk both to the airline personnel and other passengers.  And we hope that as the airlines understand these issues and come to terms with them that they will then work with us to reconnect the affected countries with the rest of the world because the current situation makes controlling the outbreak extremely difficult. 

          Spokesman: Of course, please, please.

         Dr. Margaret Chan: There is one piece of information I would like to share with you and that is in connection with the second question that Dr. David Nabarro referred to.  And if you recall the Liberian person who traveled to Nigeria and we managed to work with the airline companies to check all the passengers that have traveled from Liberia and Monrovia and they stop over in Accra and went to Toga, none of the passengers on that flight was infected. 

     So that is why I said it is legitimate and understandable airlines and crews are worried and they are anxious; but, you know, there are measures that can be taken to further reduce that risk.  So the person who was actually quite sick, he was traveling on the plane and none of the co-travelers was infected.  Thank you. 

          Spokesman: Matthew.

          Question: Sure, Matthew Lee Inner City Press on behalf of the Free UN Coalition of Access.  And thanks for the briefing.  I was listening earlier on the Médecins Sans Frontières, they said the world is failing and obviously that was kind of a headline, which obviously that was kind of a headline, but they also said that coercive measures such as laws criminalizing the failure to report suspected cases and forced quarantines are driving people underground and breed fear and unrest.  So I wonder is that the UN's position as well and is that being conveyed, for example, to Liberia where the West Point neighborhood was quarantined and to Sierra Leone where there is a law making it illegal to not report or to somehow hide victims? 

         Dr. Margaret Chan: Matthew, thank you for that very excellent question.  It is important to realize that the International Health Regulation, when it was negotiated by countries of the world took to consideration the human rights element of it.  Yes, quarantine or in some cases people call it isolation, it is a gold standard insofar as public health measures is concerned.  But in certain situations, the application, the application, is truly causing problem. 

     What do I mean by that?  Ebola, the incubation period is 21 days.  And unlike other diseases the incubation period could be three days or seven days.  It is difficult for people to be isolated for 21 days with no support of food, water and other material.  And that is why we encourage Governments who impose quarantine or isolation, to reduce the spread of the disease; they need to pay attention that all the material support are provided to the person in question as well as their family.  And that was actually articulated in the Mano River Union Communique. But I think, you know, in this instance, you know, you will refer to clearly the application of the public health measure needs to be done much better. 

          Spokesman: Thank you.  Gentleman in gray here.

          Question: [Inaudible]… the leading French radio, MSF, the Doctors without Borders said this morning that the world is losing the battle against Ebola.  And, Dr. Chan, are you losing this battle do you think? 

         Dr. Margaret Chan: It's fair to say that, you know, all organizations involved in this underestimated the complexity and the magnitude.  As I said in the last 40 years, almost 40 years, Ebola happened in locations that isolated, relatively speaking, but this time 40 years later population has grown, movement of people within a country and between countries, especially where they share common border, and their friends and relatives and talking to the people in the three countries where they have common border, I mean, it's inconceivable for them not to visit their friends especially sick ones.  So these complexities add to the fast spread of the disease.  We are not going to let go and say that we are going to let the outbreak have the upper hand.  We cannot allow that to happen.  Yes, it's going to be a big challenge.  Difficult… so that is why we need to talk to all the countries that can contribute.  The UN system will leave no stone unturned, but with support of all Governments and supporting the affected countries I think we can do it and we will do it and in the past we did it. 

          Spokesman: DSG, you wanted to add something?

         DSG Jan Eliasson: We simply cannot accept to lose this battle.  And we have to do everything we can now.  It's a huge task.  We may be in a situation where things may get worse or what.  But we have to cope with it.  And the crisis and the epidemic is manageable if we do the right things.  But what we are asking for today is immobilization of efforts that goes beyond the normal and the United Nations.  We are asking Member States to provide immediate assistance in all the areas practically that David Nabarro mentioned, the 12 areas.  And we need to have unconventional coordination ; we need to work hand and hand with Member States that can contribute and we hope certain nations take certain responsibilities in these three countries in a rather major scale and we are in talks with such nations right now.  We will have a coordination mechanism that involves not only the UN System but also these Member States.  We work hand in hand with Médecins Sans Frontières who were at the podium with us today.  And we will mobilize all the capacity available and do it in as quick way as possible in order not to lose this battle.  Thank you. 

          Spokesman: Evelyn.

          Question: Thank you.  There have been reports that Liberia no longer really has a health system, and it has collapsed.  You were there, Mr. Nabarro, and I'm wondering if that is the case and if so are peacekeepers helping or who is helping? 

          Dr. David Nabarro: Thank you very much indeed.  The health system in Liberia, in the view of the Minister for Health and the Chief Medical Officer who I was speaking with and in the view of many health workers, is not anything like its normal state and that's because the health workers have unfortunately borne the brunt of the infections with Ebola disease and also because most of the health workers that are still active are very occupied in the Ebola issue itself.  And so the health system is not strong. 

     The peacekeepers have their responsibilities.  And it would be not appropriate for me to make any comment on the extent to which they're able to contribute to other aspects of the health system except to say that they are a very limited group and the real challenge for us is to help the Liberian health system get back on its feet again and that means working directly with the authorities to do just that, which is what we are going to do.

         DSG Jan Eliasson: Can I just add to that  our peacekeepers are doing, in my view, a very good job already helping with transportation, helping with communications and even have a radio channel out there.  And so it's one of the functioning structures but we know they are not health workers but they will do whatever they can under the circumstances.  And I hope the Member States, the troop contributors will accept this very specific, very special situation in which we find ourselves. 

          Spokesman: Sangwon…

          Question: Sangwon Yoon from Bloomberg News and I have two questions for Dr. Chan and one for Dr.  Nabarro.

          Spokesman: Just one and keep it tight.

          Question: Dr. Chan, the WHO has been criticized for reacting too slowly to the outbreak and do you think any of that criticism is fair?  And also considering that the WHO has declared first polio, Ebola, as well as the Middle East the virus syndrome, do you feel that it's become extremely taxing for the organization?  What kind of cracks are you seeing, if any, in your operations and responding to this crisis?  And for Dr. Nabarro the world --

          Spokesman: Please, that is fine, let's start with Dr. Chan.  Thank you. 

         Dr. Margaret Chan: Thank you for that question.  And, as you well know, there is a lot of expectation of WHO; but we also need to be honest.  WHO is a specialized health agency.  We are not the first responder and that is an important point to underscore.  Governments are the primary provider of care.  But, of course, on the invitation of Government, at the request of Government, we would provide guidance and technical advice.  For the response, since the start of the outbreak, we have mobilized our partners, agency under the global outbreak alert response.  We have mobilized for more than 400 doctors, nurses, experts, to support the effort.  I still remember my meeting with His Excellency President Alpha Condé, before May, that was April/May period, I have made it very clear, the country has done excellent work at that stage to bring the outbreak under control.  I reminded him this is a ball that he should not drop and we should not drop.  But, as I said, the complexity and there are multiple reasons, including the denial of community, scared people running away, you know, feel the escalation of the outbreak. 

     And as I said earlier in another question, we must admit, all of us, all actors on the ground underestimated the magnitude and the complexity of this outbreak. 

          Spokesman: Thank you.  We will leave.  The DSG needs to leave, but we will -- if I can ask Dr. Nabarro and Dr. Chan to stay behind a few more minutes.

         DSG Jan Eliasson: See you later. 

          Spokesman: Matthew Carpenter.

          Question: Hi, my name is Matthew Carpenter and I'm a reporter for Yomiuri Shimbun, the Japanese newspaper.  You said that the participation of Member States is key. My question is:  Other than the affected countries which Member States are you most actively cooperating with and what capacity are you working with them in? 

         Dr. Margaret Chan: Thank you.  Of course, the affected countries we work closely with them.  But countries like US, CDC in particular and France Institute [inaudible] and as well as UK Public Health England, these are providing experts, technical support in laboratory areas, in diagnosis, and also, you know, infection control and in some instances they are actually providing experts to WHO to provide patient care.  So these are a few countries, but we have more than that.  The other countries would provide materials or support or cash. 

          Spokesman: Thank you.  Kristen Saloomey, Al Jazeera.

          Question: Thanks.  Dr. Nabarro, you mentioned food shortages.  Can you elaborate on that, where is this happening?  Why is this happening? 

          Dr. David Nabarro: Communities that are affected by Ebola virus disease are also experiencing disruption in being able to move around and that can lead to and has led to shortages of food which are dealt with locally.  But we have asked the World Food Programme to help, to make sure that there is the capacity for local citizens to respond.  Perhaps a more worrying thing is that in the longer term the capacity of the food system in affected countries to work properly has been diminished.  There are reports that planting by farmers is reduced and also that delivery of food that comes in from outside by ship has reduced because a number of ships have not docked in the ports of both Sierra Leone and Liberia recently.  That in turn is making us concerned about the longer term reduction in food availability.  Both issues are being kept under very careful observation and the World Food Programme and Food and Agriculture Organization are helping us to deal with them.

          Spokesman: Thank you, Somini, New York Times.

          Question: Thank you very much.  I meant to ask that the DSG this but I wonder if either of you could comment on whether any special precautions are necessary for the General Assembly.  And, additionally, Dr. Chan, specifically, if you could address whether you should have declared a global emergency prior to August 8 when you did?

         Dr. Margaret Chan: Thank you for that question.  Sorry.  Let me get the microphone.  And, yes, the first question is whether or not we need specific precaution for the UN General Assembly.  I think the emergency committee temporary recommendation is very clear and there should not be any travel ban.  A travel ban or closure of border is not going to help stop the outbreak from preparedness and response is the most important point.  And now the question whether or not the emergency committee can be called earlier, as I said, the emergency committee, and the most important thing is we need to look at whether or not a global coordination effort is required.  And, of course, we have to make the assessment together with the experts on the ground.  I think, you know, to us, the end of July.  And I see that, you know, when you have airport traveling somebody from Liberia, moving to Nigeria and it becomes an international travel what we call public health emergency of international concern.  So I think that is the right time to call it.  And, of course, as you said, we call emergency committee like on MERS cold virus and on polio.  But there are multiple considerations under the international health regulations, when is the right call.  And judgment has to come in place as well.  And I am guided by the advice of experts. 

          Spokesman: Thank you.  George.

          Question: Dr. Chan, I saw this morning on CNN they had I think it was Dr. Frieden and he made a great point of saying you can't close down these country, you can't isolate these countries and you have alluded to that response to previous questions as well.  Can you tell me, if that being true, how do you stop it?  What can be -- I remember years ago I was in Israel and there was talk of cholera somewhere and anybody leaving the airport got a free cholera shot, and, of course, I had to get the second one in London, is there something like that being done on any of these places?   

         Dr. Margaret Chan: I liked that question, George; and I fully support Dr. Tom Frieden's comment. Isolating these countries is not the solution.  If anything at all, it complicates the outbreak control.  Why do I say that?  As we are speaking, experts from the world through the generosity of many of your countries cannot travel to the affected countries because there is no commercial airline flying and because of the fear.  Some countries are in West Africa are closing their airlines and not airlines, their airports, not allowing UN planes to fly.  So there are consequences. 

     Now, the appropriate way to deal with it, to reduce anxiety and fear in the international community is to have very robust exit screening.  What do we mean by that?  Of course, any patient with Ebola must not travel.  Any contact, people who have come into contact with Ebola patients should be monitored for 21 days.  They would only be allowed to travel when they don't have symptoms. 

     So if countries implement that exit strategy in a robust manner, the risks of exporting Ebola case is really minimal.  And at this point in time this is, as you said, George, it's not like cholera and we don't have a vaccine and we don't have a treatment.  But let's also not forget early attention, medical attention for Ebola patients, the survival rate is higher.  And we celebrate, we should celebrate, you know, survivors as well.

          Spokesman: Thank you.  There is a small hand behind the tall BBC correspondent and I will take -- go ahead.

          Question: Small hand. 

          Spokesman: Maybe the two of you should switch seats.  Go ahead.

          Question: I'm Alexandra Olson from the Associated Press.  I was wondering if you could be a little bit more specific on what kind of contributions you're looking for from Member States in this search.  Are we talking about many -- sending many more health workers or experts?  The Doctors without Borders talked about sending military expertise or is it more material help, equipment and that sort of thing?  Thank you. 

          Dr. David Nabarro: So there is a clear menu of requirements.  Most important is to make sure that the existing services and their staff within the affected countries can work effectively and so that does mean materials in terms of what we call consumables, the things that are used up as well as basic equipment, vehicles and the support that is required, particularly training.  And then we do need people as well.  We need both healthcare professionals, but we also need people to help with the organization of support, people who know about crisis management and people who know about coordination.  Most importantly we need people who are very experienced in working to support national authorities to work as efficiently and effectively as possible.  Remember that these are countries which are experiencing a very frightening emergency right now and so, therefore, those who work with the citizens and Governments of the affected countries need to be able to display a great deal of understanding of some of the challenges they face.  I hope that is clear. 

          Spokesman: We will take two more short questions and Abdul Hameed and then Nick.

          Question: Thank you.  My name is Abdul Hameed from the London-based Arabic daily.  I hope you don't mind, Dr. Chan, to distract you a bit from Ebola epidemic and ask you about the health situation and the hazard in Gaza. 

          Spokesman: I'd like to stick to Ebola for the time being.  Nick.

          Question: Dr. Nabarro, Nick from BBC, you say the outbreak is accelerating ahead of us and it's getting harder to overtake it.  I wonder what that looks like over the coming weeks and months in terms of numbers of people infected in terms of numbers of countries affected? 

       Dr. David Nabarro: Well, it's not for me to make those projections. I think that actually it's not a wise thing to do to make those kinds of predictions because it really is not at all possible to predict.  What I am indicating to you, and I think it's well-known to everybody, is that the numbers of cases being reported are rising more and more rapidly every day.  But I think we should be prepared for the likelihood that there will continue to be more cases of Ebola being reported in coming days and weeks and this will happen that as at the same time we gather all the energies that are available internationally to get ahead of the outbreak and get it under control. 

     And, secondly, I think we must anticipate that there will be cases appearing in other countries, that's what happens with these kinds of diseases.  But we should take some -- I think some solace from the reality that when it has spread to other countries there has been a very rapid response, which is the way it should be.  Thank you. 

          Spokesman: Great.  Thank you very much, and thank you very much.