Ebola

Lord Patel Excerpts

Thursday 8th January 2015 Lords Chamber

[Lord Patel (CB)]

My Lords, I, too, thank the noble Lord, Lord Fowler, for initiating this debate. I thank him also for his brilliant speech and for his great concern for those who volunteer to do this work. I associate myself with the comments that he made about Pauline Cafferkey and I wish her a speedy and complete recovery.

I want to speak on four issues as far as the lessons learnt are concerned. Could the crisis have been spotted earlier? Was the UK’s response timely and appropriate both in scale and support? What needs to happen to cope with future pandemics? Did the UK have appropriate safeguards for NHS and other volunteers who went to Sierra Leone, including on their return?

Peter Piot, in his book No Time to Lose, described the dramatic effects of Ebola infection since its outbreak in 1976 and warned us to be prepared. Previous outbreaks were controlled by prompt notification, deployment of specialist teams, quarantining of exposed individuals and isolation of patients, but the lessons were not learnt. The current outbreak started in Guinea at the end of 2013. Despite hundreds of deaths, neighbouring countries did not take any notice. Surveillance systems were not effective and warnings from organisations such as Médecins Sans Frontières were ignored. Official agencies were either complacent or did not have the resources or personnel in place to monitor the outbreak. Hundreds died. Worse, in countries where health workers were in poor supply, several hundred health workers died.

Did the WHO botch its response to the developing crisis in Sierra Leone and Liberia? The answer is most likely yes, but the question is why. Africa office representatives were not filing Ebola reports to the head office. There are lessons here as to how the WHO, the only global health agency, should operate in the future and how its performance could be improved. There is no doubt that its effectiveness was weakened by decades of policy failures and budget cuts by wealthy nations trying to fund their deficits. Wealthy nations need to restore their funding of the WHO. The Ebola crisis has confirmed a new reality: that we live in a shrinking world. To cope with future pandemics—which are sure to come and might be worse than the current pandemic—strong international organisations working with national organisations is absolutely necessary.

My second point relates to the UK response. Here I can do nothing but congratulate the UK Government on the speed with which they responded, with both personnel and finances—the second-highest donor nation after to the United States—and commend the continuing effort that DfID and WHO are making to bring this crisis to an end. We need to learn lessons as to whether we could have done better—it is always possible to have done better—but, hitherto, I have nothing but praise for our Government.

This leads to my third, and important, point—already mentioned by the noble Lord, Lord Fowler, and other noble Lords: what should we do about future pandemics? Why were countries such as Guinea, Sierra Leone and Liberia not able to cope with the crisis, when countries such as Nigeria curtailed it very quickly? The answer is very poor health systems, as has been mentioned: lack of facilities or equipment, deficit of a health workforce, lack of appropriate public health measures, and lack of surveillance and controls. Both Larry Summers, the previous Treasury Secretary of the US, and Bill Gates, when he spoke in the Robing Room, asked for help in developing health systems in those countries.

Larry Summers’s report, Global Health 2035, published in the Lancet, identifies that we will need some $30 billion a year for the next decade. Building health systems requires time and money, and the richer nations of the world need to come up to the plate to develop that. Otherwise, we will continue to have such crises, which will begin to affect us even more than they do now. The UK can take a lead in building health systems. We are the right country to do so because we have demonstrated that we can have effective influence.

My fourth point relates to whether the UK’s support for our NHS volunteers has been appropriate. It is important that we make sure that people who volunteer to go to affected countries are in a safe environment, are able to work safely and can return home safely afterwards. Comments that we have seen in some of the media, particularly social media, demonising those who return from such work, are unacceptable. Sarah Wollaston, MP for Totnes and chair of the Health Select Committee wrote a very good article about this in the Telegraph. I was disappointed to learn—if accurate—that some BBC staff feel that they can no longer interview in person people who come back from west Africa, and therefore that a telephone interview would be more appropriate. Brave BBC workers have reported from there, but such comments from the media—if correct—are also inappropriate.