The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)
My Lords, with the leave of the House, I shall now repeat a Statement made earlier this afternoon by my right honourable friend the Secretary of State for Health on the subject of Ebola.
“With permission, Mr Speaker, I would like to update the House on the Government’s response to the Ebola epidemic in West Africa. I shall start with the Chief Medical Officer’s assessment of the current situation in the affected countries. As of today, there have been 4,033 confirmed deaths and 8,399 confirmed, probable and suspected cases of Ebola recorded in seven countries, although widespread transmission is confined to Liberia, Sierra Leone and Guinea. This number is doubling every three to four weeks. The UN has declared the outbreak an international public health emergency.
This Government’s first priority is the safety of the British people. Playing our part in halting the rise of the disease in West Africa is the single most important way of preventing Ebola infecting people in the UK. I would like to start by paying tribute to the courage of all those involved in this effort, including military, public health, development and diplomatic staff. I particularly commend over 650 NHS front-line staff and 130 Public Health England staff who have volunteered to go out to Sierra Leone to help in our efforts on the ground. You are the best of our country and we are deeply proud of your service.
Among the three most affected countries, the UK has taken particular responsibility for Sierra Leone, with the US leading on Liberia and France focusing on Guinea. British military medics and engineers began work in August on a 92-bed Ebola treatment facility in Kerry Town, including 12 beds for international health workers. In total, we will support more than 700 beds across the country, more than tripling Sierra Leone’s capacity. With the World Health Organisation, we are training more than 120 health workers a week and piloting a new community approach to Ebola care to reduce, and hopefully stop, the transmission rate. We are also building and providing laboratory services, and supporting an information campaign in-country. We are now deploying the Royal Navy’s RFA “Argus” and its Merlin helicopters along with highly skilled military personnel, bringing our military deployment to 750. They will support the construction of the Kerry Town Ebola treatment centre and other facilities, provide logistics and planning support, and help establish and staff a World Health Organisation-led Ebola training facility to increase training to over 800 health workers a week.
Taken together, the UK contribution stands at £125 million plus invaluable human expertise and is the second-highest bilateral contribution after the US. But we need other countries to do more to complement the efforts of ourselves, the US and France. On 2 October, the Foreign Secretary held an international conference on defeating Ebola in Sierra Leone, during which over £100 million and hundreds of additional healthcare workers were pledged.
I will now move on to the risks to the general public in the UK. The Chief Medical Officer, who takes advice from Public Health England and the Scientific Advisory Group for Emergencies, this morning confirmed that it is likely that we will see a case of Ebola in the UK, and that this could be a handful of cases over the next three months. She confirmed that the public health risk in the UK remains low and that measures currently in place, including exit screening in all three affected countries, offer the correct level of protection. However, while the response to global health emergencies should always be proportionate, she also advises the Government to make preparations for a possible increase in the risk level.
Therefore I can today announce that the following additional measures will take place. First, on screening and monitoring, rapid access to healthcare services by anyone who may be infected with Ebola is important, not only for their own health but also to reduce the risk of transmission to others. While there are no direct flights from the affected region, there are indirect routes into the UK. Therefore in the next week Public Health England will start screening and monitoring UK-bound air passengers, identified by the Border Force, coming on the main routes from Liberia, Sierra Leone and Guinea. This will allow potential Ebola virus carriers arriving in the UK to be identified, tracked and given rapid access to expert health advice should they develop symptoms.
Those measures will start tomorrow at Heathrow, which receives around 85% of all such arrivals, beginning with terminal 1. They will be expanded by the end of next week to other terminals at Heathrow and Gatwick and on the Eurostar, which connects to Paris and Brussels-bound arrivals from West Africa. Passengers will have their temperature taken and complete a questionnaire asking about their current health, recent travel history and whether they might be at potential risk through contact with Ebola patients. They will also be required to provide contact details. If neither the questionnaire nor the temperature reading raises any concerns, passengers will be told how to make contact with the NHS should they develop Ebola symptoms within the 21-day incubation period, and allowed to continue on their journey. It is important to stress that a person with Ebola is infectious only if they are displaying symptoms.
Any passenger who reports recent exposure to people who may have Ebola, or symptoms, or who has a raised temperature will undergo a clinical assessment and, if necessary, will be transferred to hospital. Passengers identified as having any level of increased risk of Ebola, but without any symptoms, will be given a Public Health England contact number to call should they develop any symptoms consistent with Ebola within the 21-day incubation period. Higher-risk individuals will be contacted on a daily basis by Public Health England. Should they develop symptoms, they will have the reassurance of knowing that this system will get them first-class medical care, as the NHS demonstrated with nurse William Pooley, and the best possible chance of survival.
We expect these measures to reach 89% of travellers we know have come to the UK from the affected region on tickets booked for the UK. However, it is important to note that no screening procedure will be able to identify 100% of the people arriving from Ebola-affected countries, not least because some passengers leaving the countries will not be ticketed directly through to the UK. So today I can announce that the Government will ensure, working with the devolved Administrations, that there is highly visible information displayed at all entry points to the UK asking passengers to identify themselves, in their own best interests, if they have travelled to the affected region in the last 21 days. This information for travellers will be available by the end of this week.
We are also taking other important measures. We have tested operational resilience with a comprehensive exercise that took place on Saturday, modelling cases in London and the north of England. Local emergency services across England are holding their own exercises this week and will share lessons learnt.
It is vital that the right decisions are made on Ebola following any first contact with the NHS. So we have put in place a process for all call handlers on NHS 111 to ask people reporting respiratory symptoms about their recent travel history so that appropriate help can be given to higher-risk patients as quickly as possible. The Chief Medical Officer has also issued a series of alerts over recent months to doctors, nurses and pharmacists setting out what to do when someone presents with relevant symptoms. We will also send out guidance to hospital and GP receptionists.
The international profile of the UK as a favoured destination inevitably increases the risk that someone with Ebola will arrive here, so a great deal of planning has also gone into procedures for dealing with potential Ebola patients in the UK, working closely with the devolved Administrations. All ambulances are equipped with personal protective equipment, PPE. If a patient is suspected of having Ebola, they will be transported to the nearest hospital and put in an isolation room. A blood sample will then be sent to Public Health England’s specialist laboratory for rapid testing. If they test positive for Ebola, they will be transferred to the Royal Free Hospital in North London, which is the UK’s specialist centre for treating the most dangerous infectious diseases. We also have plans in place to surge Ebola bed capacity in Newcastle, Liverpool and Sheffield, making a total of 26 beds available in the UK.
We will always follow medical advice as to whether any measures we adopt are likely to be effective and are a proportionate response to risk. However, I believe that we are among the best and most prepared countries in the world.
Lastly, we are harnessing the UK’s expertise in life sciences to counter the threat from Ebola. The UK Government, alongside the Wellcome Trust and the Medical Research Council, have co-funded clinical trials of a potential vaccine which could be pivotal in the prevention effort. We are actively working with international partners to explore how we might appropriately make further vaccine available.
Finally, we should remember that the international community has shown that if we act decisively, we can defeat serious new infectious disease threats such as SARS and pandemic flu.
The situation will get worse before it gets better, but we should not flinch in our resolve to defeat Ebola both for the safety of the British population and as part of our responsibility to some of the poorest countries on the planet. Our response will continue to develop in the weeks and months to come, guided by advice from the Chief Medical Officer, Public Health England and the Scientific Advisory Group for Emergencies.
I commend this Statement to the House”.
My Lords, that concludes the Statement.
Earl Howe
My Lords, I am very grateful to the noble Lord for his comments and questions. I shall endeavour to cover as many as I can. First, let me turn to the advice that we have received in recent days from the Chief Medical Officer. It is important for me to underline that she has made it clear that we can expect a small number of cases over the next few months but that the degree of risk to the UK remains low. That is the point which noble Lords should keep in mind. It makes sense that we should identify people who have been to the affected areas and give them clear advice, making sure that they know exactly whom to call to get access to the best possible advice and care. The evidence from the Texas case, which the noble Lord cited, is that early identification of cases is absolutely critical and screening will help with that.
The noble Lord mentioned that the position of the Department of Health has changed over recent days. He is right; the Chief Medical Officer has been very clear that we are in uncharted territory so far as Ebola is concerned. We will learn as we go and base our policy on the best possible advice but we took the view that, as a Government, we would be failing in our duty if we did not take proportionate and targeted steps to safeguard the UK. The situation is developing all the time. No system of screening, as the Statement made clear, can offer 100% protection against an imported case of Ebola but our aim is to ensure that as many people as possible arriving from affected countries know the symptoms and how to get access to healthcare services as quickly as possible. We can be entirely confident in our ability to isolate and treat a case in this country, should it emerge, and we believe that the measures which we have announced will help to improve our ability to detect and isolate Ebola cases.
The noble Lord asked what modelling had been done on the number of cases. I am advised that a great deal of work has been done in an endeavour to predict numbers. I cannot give a precise number but the CMO’s advice is based on a risk assessment from Public Health England and she has been clear that, although the risk remains low, we should be prepared for a handful of cases over the coming months.
The noble Lord asked whether we had been planning for a worst-case scenario. As I said, the NHS has capacity available to cope with a number of cases. We are confident that the NHS’s capacity is adequate. We have two specialist beds available using the Trexler system at the Royal Free. There is further capacity at the Royal Free itself and surge capacity at a number of other units around the country. It is important, however, to understand that Trexler beds are not the only type of beds that can be used; other beds are appropriate for treating Ebola patients, given that the staff have appropriate PPE.
Turning to the prospects for treatment of Ebola, we are using our position as a global centre of research to understand Ebola better and help prevent a future outbreak. Working with the Wellcome Trust, we have launched a global call for research which could produce evidence to better manage the current outbreak and any that occurs in the future. The UK, alongside the Wellcome Trust and the Medical Research Council, has also co-funded clinical trials of a potential vaccine, as was mentioned in the Statement, which could be pivotal in preventing outbreaks. At the moment I am not in a position to give further details of that work.
The reassurance to the House is that there is now an expert group, chaired by the Chief Medical Officer, alongside Jeremy Farrar of the Wellcome Trust. The Chief Medical Officer and Sir Mark Walport, the Government’s Chief Scientific Adviser, have agreed that this group should be a SAGE group—that is, a Scientific Advisory Group for Emergencies. This will include the best experts that we have available.
The noble Lord asked me about international support for the effort in Sierra Leone on top of the support that we are providing from this country. As a result of the conference held in London on 2 October, a number of countries and organisations have made pledges. Australia has pledged £6.2 million, Canada £18.6 million and Switzerland £3.25 million. Cuba has pledged a significant number of staff. At the African Development Bank a further £94.9 million package of grants and loans has been approved, of which £31 million will go to Sierra Leone. Save the Children is launching a £44 million appeal, with £25 million for Sierra Leone.
Turning back to the UK, the noble Lord asked me about GPs and whether they know how to identify Ebola and what to do. As the Statement mentioned, the CMO has sent out a number of alerts, including to GPs. We are not at all complacent about this. We are asking the Royal College of General Practitioners and the BMA about how we could get messages out more effectively to their constituent members, as they have very good channels of communication.
Finally, I hope that I have sufficiently conveyed to the House that there is clear responsibility for the efforts that we are making in this country and in Sierra Leone to contain this outbreak. Ultimately, Ministers are accountable but, as I said, we have a SAGE group in operation; we have Public Health England providing advice to that group, along with the advice of other experts. The lines of accountability are clear.
Lord Patel (CB)
My Lords, I thank the noble Earl for his Statement. I have two quick questions. One relates to the staff who have volunteered to go out to Sierra Leone and to all soldiers. If any of them get infected while they are working there, will they be brought back to the United Kingdom for treatment? My second question relates to the treatment. While there are likely to be early trials of the vaccine that is being developed, it may well prove ineffective. But there are other companies developing other treatments. Are there plans to fast-track approval of these drugs if they are found to be effective? We know that the stock of ZMapp is now exhausted; further monoclonal antibodies development is likely to take some time.
Earl Howe
There is a limited amount that I can say to the noble Lord about his second question. A general answer is that we would naturally want to give as fast a passage as possible through the regulatory process to any breakthrough treatment for Ebola. It should be borne in mind, however, that safety is the paramount concern. This is why it is important that the vaccine, which is now in clinical trials, is thoroughly tested for safety as well as efficacy. If there is further news on this that I can impart to the noble Lord, I will be happy to write to him.
The noble Lord asked whether staff who volunteer will be repatriated if they contract the disease. My advice is that decisions on repatriation would be taken on a case-by-case basis, taking into account the clinical condition of the person and the benefit they may gain from repatriation. Repatriation involves a long journey that can potentially be dangerous for the patient. Once there is high-quality treatment available in Sierra Leone, it will not necessarily be in the best interests of the patient to be repatriated. That is why we are building the 12-bed unit specifically for national and international healthcare workers.
Lord Fowler (Con)
My Lords, I totally support the measures set out by the Minister. It is obviously sensible, as it has been in past events, for the Government to follow carefully the guidance of the Chief Medical Officer. Is not the real long-term task permanently to strengthen the inadequate and underfinanced health systems in so many parts of Africa? Would that not be to the benefit of tackling not just Ebola but other life-threatening conditions such as malaria, TB and HIV/AIDS?
Earl Howe
My noble friend has immense experience in this area and I completely agree with him. I attended a conference in Washington a few days ago which was called by the President of the United States at which 44 Health Ministers from around the world were present. I emphasised the very point my noble friend has made: yes, it is important to provide assistance to deal with the current emergency—everybody is agreed about that—but we must not lose sight of the need for the health systems in those poor countries to be bolstered in the way my noble friend mentioned and for there to be adequately trained clinicians and healthcare staff on the ground as well as diagnostic facilities so that in future those countries are capable of some resilience if they are hit by such an emergency again. I can tell my noble friend that DfID funding is going into that effort, as it has been systematically over the past few years.
Lord Boateng (Lab)
My Lords, the President of Ghana and chair of ECOWAS—the affected region—will be visiting the United Kingdom next week. He will be received graciously by Her Majesty the Queen, and he will come to this House on 22 October in order to address Members of this House and the other place. The success of the welcome measures outlined by the noble Earl will depend on the active engagement and involvement of West Africa and the whole of the affected region. Will the Minister ensure that the request that the President has put in to meet the Prime Minister and Cabinet members in order to discuss the appropriate co-operation between West Africa and the United Kingdom on these measures will be granted? The President has already made clear, and will make it clear to Members of this House next week, the appalling shortage of PPE and safety equipment on the ground in West Africa as we speak. There is a vital need for further resources and increased co-operation. The Prime Minister and Cabinet Ministers need to hear that message.
Earl Howe
My Lords, I am grateful to the noble Lord for giving me prior notice of his question. We very much look forward to the visit of the President of Ghana. His wish to discuss the Ebola emergency with the Prime Minister or a member of the Cabinet has been fed through at the highest governmental level. I cannot yet confirm whether or with whom such a meeting might be arranged, but I have asked that a response be forthcoming to the Ghanaian High Commission as soon as possible.
Baroness Hamwee (LD)
My Lords, the noble Earl mentioned information to GPs, pharmacists and so on. Can he tell the House anything about information to be given to the general public about the symptoms that we should be looking out for? Obviously I appreciate that one does not want to cause alarm, although I think the public are likely to be alarmed anyway, nor to overwhelm the services, but I imagine the Minister would agree that information is important.
Secondly, can he say anything about advice to air passengers? I do not mean those coming directly from the countries that we know are affected, but all air passengers. I imagine that all of us after a plane journey have got off thinking, “Hmm, with all that stale air, I think I’m about to go down with something—I can feel it at the back of my throat”. Are there precautions that air passengers generally should be taking? If so, will there be advice about this?
Earl Howe
My Lords, we are reviewing those very questions all the time. Our position at the moment is that it would be disproportionate to alert the general public to the risk of Ebola, because it remains low. As for air passengers generally, it is important to understand that the virus is transmitted only by direct contact with the blood or bodily fluids of an infected person. It is not an airborne infection. So while I do not in the least belittle the importance of a public health campaign should that prove necessary, we do not consider that it is warranted at the current time.
Lord Winston (Lab)
My Lords, I am slightly concerned—I hope the noble Earl will forgive me for not giving him advance notice of this question—about the possible risk of seeming a little complacent about saying that this is low-risk. We know that viruses mutate, for example, and we know that the Ebola virus can mutate. We know perfectly well that it is not airborne at the moment, and we know that the pharyngeal and upper respiratory tract cells are unlikely to harbour the virus. However, can the noble Earl assure us that people are looking at the risk of mutation of this virus so that we can make certain that its mode of transmission does not change and that, therefore, it will continue to be low-risk?
Earl Howe
I can give the noble Lord that assurance. There is very close monitoring of the virus itself and the way in which it mutates. I repeat that the official advice is that risk to the public in this country remains low. That advice is based on the fact that we have robust, well developed and well tested systems for managing infectious diseases when they arise, supported by a wide range of experts. The Chief Medical Officer has estimated that we should expect Ebola in the UK, but not more than a handful of cases, and we would be able to cope with those cases.
Lord Alton of Liverpool (CB)
My Lords, does not the handful of cases to which the noble Earl has just referred contrast very sharply with the prediction that 1 million people may die in West Africa? Given the fetid conditions and grinding poverty in places such as Monrovia and Freetown, does he not agree that this public health epidemic has been brought about because of the conditions that we have allowed to fester for so long?
Would the noble Earl not agree that the WHO was very slow in responding when this was first identified? Does he not also agree that an immediate problem is the disposal of corpses, which carry the risks of contagion? Furthermore, when will the 700 beds in Sierra Leone to which he alluded actually come on line?
Earl Howe
My Lords, I believe that the WHO itself has acknowledged that its response could have been swifter. It is easy to say this in hindsight, but I am sure that the noble Lord’s view on that is shared by others. Nevertheless, the WHO has not been slow in rallying support for efforts in the three countries affected. It is now working energetically with many developed countries to provide support, and I would not wish to criticise the WHO in those respects.
On the disposal of corpses, the noble Lord makes an important point. We know that many cases of Ebola in the three countries have arisen as a result of people being in contact with the corpses of people who have died from the disease. That has been as a consequence of the cultural traditions in those countries, which are very hard to displace or persuade people not to follow. It is nevertheless part of our effort in Sierra Leone that we should inform people there that their burial customs need to be set to one side for the duration of the epidemic. This is a very difficult thing to do, for understandable reasons, but that is the effort we are making and it is bearing fruit.
As to the programme for building 700 beds, I do not have a precise date to give the noble Lord but if I receive advice before the end of this debate, I shall tell him.
Lord Reid of Cardowan (Lab)
My Lords, manifestly, this is a terrible disease, not only in its nature but in its scale. According to the rate of growth indicated by the Minister, within around six months we could be looking at between 150,000 and 500,000 deaths, and between 2 million and 5 million suspected cases. Let us hope that that does not occur. However, in view of that, may I ask him one question about screening and entry? I welcome the fact that there is to be extended screening at Heathrow, Gatwick and the Eurostar terminal—two airports and one train station. Manifestly, this does not cover anything like the potential entrants to this country from those regions. With cheap travel and so on, I understand the difficulties in covering every airport, particularly as people break their journeys and do not come directly. However, is it not possible, given the use of so many biometric passports and the technology introduced to UKBA, somehow to target at least people from that area as potentials for screening, wherever they arrive in this country, rather than limit the coverage to three geographical in-ports? Does the Minister have any information on whether this hypothesis has even been tested?
Earl Howe
My Lords, I am grateful to the noble Lord. Existing technology used by the Border Force can inform it about individual passengers coming to this country and identify those who have recently travelled from Liberia, Sierra Leone and Guinea on routes with onward connections to the UK. Systems are therefore in place. We know that fewer than 1,000 passengers arrived by air from the affected countries in September. We are not therefore dealing with huge numbers. We know that around 85% of such people arrive at Heathrow, which is why we are starting there. However, it is important to look as widely as we can; the noble Lord is right. Again we should be reassured by the fact that there is screening on departure from Liberia, Sierra Leone and Guinea but we are starting the in-country screening in the UK at the three ports I mentioned, with the intention of scaling up screening, based on our experience. Plans are in place for a further rollout to other UK ports, if that should prove necessary.
The Countess of Mar (CB)
My Lords, my noble friend Lady Finlay of Llandaff has asked me to apologise to the House for her absence; she had to go to Wolverhampton. I hear the noble Earl saying that the department will consult the BMA and the RCGP about getting the message across to GPs. My noble friend asked me to ask whether a diagnostic algorithm was going to be posted on all appropriate websites, including those of the royal colleges and the BMA.
Earl Howe
I am not aware that the system being conveyed to GPs, which is not for diagnosis but for the referral of patients, can be called an algorithm, but there is a checklist of questions that we are recommending GPs use. That advice has been adapted for use in all healthcare settings, including NHS 111, as I mentioned in the Statement. Naturally, we shall take advice on whether the questionnaire and the sequence of questions are adequate. If it needs amending, we shall certainly not hesitate to do that.
Baroness Andrews (Lab)
The Minister mentioned SARS in his Statement. We have very few precedents, and he has already described this as being uncharted territory in relation to Ebola. What lessons were learnt after the SARS epidemic, particularly in relation to the organisation of global research? It was a different case because the virus was unknown but the same issues of mutation came up as those to which my noble friend referred. How will the lessons learnt be applied?
Earl Howe
The main lesson learnt from SARS, which in general was a very successful exercise, was that there are two keys to this. The first is informing people what to do if they think that they have symptoms, and the second is making sure that the NHS knows what to do if presented with a possible case of the illness. I hope my comments have conveyed that those two things are the focus of our activity in this country. We also need to make sure that adequate isolation facilities are available for patients with these highly transmittable conditions. That work has been done in the mean time, hence the isolation facilities at the Royal Free and other hospitals to which I have referred.
Baroness Warnock (CB)
With regard to research, could the noble Earl reassure us that the clinical trials will be speeded up by waiving the normal practice of control procedures? It seems unethical to use blind control in a case where the consequences of not being treated are fatal.
Earl Howe
I completely take the point of the noble Baroness, and there are processes on which we can draw to ensure that breakthrough treatments are fast-tracked. There are, however, certain necessary stages in testing any new vaccine or treatment that comes forward to make sure that it is safe. It may be clinically effective in its own way but have unacceptable side-effects, so we need to test that. I can reassure her that regulation will not stand in the way of making a breakthrough treatment available.
To answer the earlier question of the noble Lord, Lord Alton, I shall write to him with further details, but the 700-bed facility is under construction now. The first facility as part of that will be open by the end of October in Kerry Town.