Ebola

Lord Fowler Excerpts

Thursday 8th January 2015 Lords Chamber

Asked by

[Lord Fowler]

To ask Her Majesty’s Government what lessons they have learnt from the recent Ebola outbreak in West Africa.

[Lord Fowler (Con)]

My Lords, I welcome the opportunity of this short debate. First, I would like to pay tribute to the brave people who have gone from other countries, very much including the United Kingdom, to help tackle the outbreak of Ebola in west Africa. Obviously, I am thinking of Pauline Cafferkey, being treated at the Royal Free Hospital in London, and we all very much pray for her recovery. But I also pay tribute to all the others from different occupations and disciplines who have gone to help, including the 70 volunteers from the National Health Service. They have put their own health at risk and we should remember that, among the 680 healthcare workers who have contracted Ebola since the first outbreak of the disease, no fewer than 400 have died. These men and women have come from other countries in Africa and from around the world and have paid a terrible price for their altruism and selflessness.

Of course, the major casualties of the outbreak have been the 8,000 men, women and children who have died so far in countries such as Sierra Leone, Liberia and Guinea. There is perhaps a failure of imagination by us in the West about what a bare statistic such as that means for families on the ground—the individual tragedies that make up the total, with families torn apart and children left without one or both parents. The epidemic may have now reached a peak, I hope, but whether it has or not, one point is certain: we need to examine what measures should be taken to prevent further epidemics on this scale.

It is also worth remembering that any policy changes that may result from Ebola may also have the effect of helping in the fight against other diseases such as AIDS, TB and malaria, where the death toll is actually even greater. Around the world today there are 1.5 million deaths from AIDS each year, a further 1.5 million from TB and 600,000 from malaria—predominantly of children. The challenge must be to reduce radically this entirely unacceptable total of death.

What are the lessons that we can draw so far from the latest Ebola outbreak? I suggest that there are at least three. The first is that one of the reasons why the Ebola epidemic has spread so widely, so quickly and with such devastating effect is that in many parts of sub-Saharan Africa health systems are inadequate; the staff are under enormous pressure and their working conditions are often far below what any of us would consider acceptable in this country. Again, there is perhaps a failure to recognise the conditions in which medical staff have to struggle to make an impact. A few months ago I went not to west Africa but to Uganda and visited a hospital on the banks of Lake Victoria which had not received a budget increase for 10 years. Inadequate and underfinanced health systems remain the truth in so many African countries.

Sierra Leone is a prime example. The country lies 11th from bottom of the United Nations Human Development Index. The figures for infant, child and maternal mortality are bad even compared with neighbouring Liberia. Up until the crisis, Sierra Leone, with a population of around 6 million, had something like 136 doctors and 1,000 nurses to care for the population. The Health Secretary said in the other place on Monday that the Government,

“have committed more than £230 million to fight the disease in Sierra Leone”.—[Official Report, Commons, 5/1/15; col. 40.]

That is enormously welcome and makes Britain one of the biggest contributors in the world. However, my concern is not just what we are doing now but what we did before to strengthen the health system and what we will do in the future, because the whole need is for consistent policy applied year after year. My concern is that, once emergencies are over, there is a tendency for countries to fall off the agenda. We treat the casualties but we do not do enough to prevent those casualties taking place.

An excellent all-party report by the House of Commons International Development Committee, under the chairmanship of Sir Malcolm Bruce, found a strange lack of interest among the NGOs in even giving evidence on the position prior to the Ebola outbreak. The committee would have expected something like 100 pieces of evidence; it received 10. In passing, I pay tribute to Marie Stopes, Plan and Save the Children for being the exceptions to this trend. Unfortunately, the same view seems to have been taken by DfID. In paragraph 33 of its report, the committee found that bilateral programmes directly managed by DfID for Sierra Leone and Liberia were planned to reduce by £14.5 million in 2014-15 compared to the previous year, a reduction of around 19%. The committee commented that it was “appalled” that the budget was being cut in this way. Since then, policy has changed. Emergency money has been put in. A vast effort is being made to help. I welcome that, but my view remains that the priority of policy should be, above all, to provide consistent support for a country such as Sierra Leone, which is one of the poorest in the whole world.

My second point also concerns consistency. I declare an interest as a non-executive director of the International AIDS Vaccine Initiative, which is a non-profit organisation working to develop a vaccine for AIDS. My point today is a more general one about vaccines. If we can develop them successfully, this can have a dramatic effect, as we have seen in a number of countries in relation to the polio vaccine. But there is one point about vaccine development that is also absolutely certain. They take a long time to develop—sometimes a very long time. For example, the polio vaccine took 47 years to develop and the whooping cough vaccine took 42; with some of the diseases—malaria, for example—the search has been continuing for well over a century. The development time has a number of impacts. It means that the pharmaceutical industry is not always able or willing to invest what could be very substantial sums in development. The result is that, in my view, there is a particular responsibility on Governments to finance development here. The United States does a vast amount in this respect. I fear no one would claim that the United Kingdom proportionately does the same.

The third and final lesson that I believe we should examine is the medical staffing position of some of the poorest countries in Africa to see whether the developed world is taking too many of the doctors and nurses who have been trained in Africa but then come to work and settle in countries of the West and the Middle East, including the United Kingdom, of course. Let me be absolutely clear: the doctors and nurses who have come here have made an invaluable contribution to the health service. There is no doubt about that. But that is not the end of the story. Seen from Africa, the problem is that many of the doctors and nurses who have been trained at some expense have left Africa, which is in vast need of their care, to go abroad. Taking Sierra Leone as an example, around 600 members of National Health Service staff received their primary medical qualification in Sierra Leone. That is small in our terms but absolutely massive in terms of Sierra Leone. Relatively few return.

I do not claim that it is going to be easy to reverse that trend. It is a question not just of salary but of the medical conditions to which doctors and nurses will return. What we should be aiming at is a situation where there is investment in inward migration but also in outward migration—a two-part thing. It is neither desirable nor possible to have a blanket ban on the immigration and emigration of medical staff. Ideally, it should be a two-way process, as an excellent report by VSO makes clear. But what is clear at the moment is that Africa appears to be a very heavy loser from this process and that we in the West would do well to mount an inquiry to see what can be done to correct that position.

These are just three questions that the Ebola crisis raises: whether we are doing enough to develop and produce vaccines; whether our policies in the West are taking away a disproportionate number of doctors and nurses from African countries which badly need them; and, above all, how we can further strengthen the health systems of countries such as Sierra Leone so that further human tragedies can be prevented. My hope is that the tragedy of the Ebola outbreak today may point the way to producing more permanent answers for the future.