Sub-Saharan Africa: Healthcare

Baroness Northover Excerpts

Thursday 16th July 2015 Grand Committee

[Baroness Northover (LD)]

My Lords, I, too, thank the noble Lord, Lord Boateng, for securing this important debate and introducing it so effectively. The last time we debated this issue in the Lords was, I think, in a debate put down by the noble Lord, Lord Fowler, at that time my noble friend, and I was fortunate to be the DfID Minster replying. In that position, I was privy to the absolutely outstanding efforts made by DfID to counter this epidemic in Sierra Leone.

Ebola illustrated, in the most appalling way, how we are all interconnected. Not only did we have a moral responsibility to respond to what was happening in Sierra Leone, a country in the development of which we played such a key role after its civil war, but it was and is in our self-interest to do so. We are all so interconnected globally that an epidemic such as this can easily move across continents, as we have heard, out of control. When that patient arrived and died in Nigeria, the world was fortunate that a nurse, in effect, gave her life ensuring that this patient was not allowed to leave the clinic, with appalling consequences for the nurse herself but astonishing protection for the people of Nigeria and the wider world. Indeed, they used the system for polio, but it was helped by the first case being received in the private clinic that it was. Too easily, the epidemic could have reached widely round the world.

We were lucky too, in my view, that we had in DfID, as Chief Scientific Officer, the outstanding Chris Whitty, from the London School of Hygiene and Tropical Medicine. There could not have been a better person to set about organising the UK’s comprehensive response to Ebola in Sierra Leone.

While the US concentrated on Liberia and France led in Guinea, work was undertaken at every level. Clinics were set up locally where patients could be identified, and those with Ebola sent to dedicated units. Lab facilities were improved to speed up diagnosis. Work with anthropologists was undertaken to work out practices which enabled those who had lost loved ones to have rites of passage which did not endanger all mourners. The development of treatments and vaccines was expedited. As my noble friend Lady Walmsley said, NHS volunteers were identified and trained to work as safely as possible in Sierra Leone. I pay tribute to them and to UK-Med.

When I answered the debate earlier this year, we seemed to be within striking distance of ending this epidemic. We seemed to have done so in Liberia. I would like to know whether the cases in the three countries are traceable to other known cases, or whether some do not fall into this category. What are the implications in either case?

The World Health Organization has rightly been criticised for its tardy response, lack of resources and inappropriate personnel in the region and elsewhere. What progress can be reported? What have we learned in terms of surveillance, early warning and response systems? How do we identify and respond to potential crises in future?

The Government of Sierra Leone were understandably keen to be supported as they rebuilt. Are we ensuring that such rebuilding is fully transparent and accountable? There was huge concern that other patients —for example, those with malaria—did not come to clinics lest they were infected with Ebola, and that vaccination and treatment for other diseases fell away. Will the noble Baroness give an estimate of the associated mortality and tell us what is being done to address this?

There has been huge concern, as others have mentioned, that children spent a long time out of school. What is being down to ensure that they make up for lost time? What is being done to support orphans, who have been mentioned? How are we best supporting women and girls, given that they are especially vulnerable, as my noble friend Lady Walmsley pointed out? The International Development Select Committee and others expressed concern about the weakness of the health systems that allowed the epidemic to take hold, and concern that these should now be strengthened. Like the noble Lord, Lord Giddens, I want to know what is being done to address that area. It is one thing to intervene in a humanitarian crisis like this, with popular support, but it is quite another to sustain long-term investment. What is the financial size of the commitment being made by DfID?

I would appreciate an update on treatments and vaccines. It was excellent that in the crisis, because of the work after 9/11, particularly by the Americans, there was some progress which could be built on. I would like to know how the vaccines from the UK, especially from the Lister Institute, have been faring. There was the proposal, of course, that we should take a shared public risk in developing these. Clearly, on the one hand, this could be an opportunity for drug companies to avoid their responsibilities. On the other hand, there could be a public good involved. The Minister’s noble friend, the noble Lord, Lord O'Neill, has discussed such public pooling of risk in relation to the development of antibiotic-resistant drugs. Where are we in relation to Ebola treatments and vaccines? How do we protect from abuse by the pharmaceutical industry in this area? Are there proposals for delivering more rapidly clinical trials in this field? How might production be scaled up and adequate delivery put in place? What work is being carried out to assess other potential disease threats which may quickly cross borders in our globalised world?

I came across one bright note in relation to Ebola. Sierra Leone has a high incidence of FGM. From what I understand, in the civil war this stopped. It re-started thereafter. I heard that it stopped again in the Ebola epidemic. It seems to me to be vital—this is what I urged and I want to know exactly what we are now doing—that we build on that change. We cannot allow things simply to return to normal. If we can change people’s burial practices, surely we can, and must, address this terrible practice as well.

I would also like to ask what lessons have been learned about the deployment of NHS staff. UK-Med seemed to do a remarkable job. Like my noble friend Lady Walmsley, I pay tribute to it. I am sure that it will be learning lessons, which we will need to apply in other humanitarian emergencies. I look forward to the Minister’s response and pay tribute again to the astonishing efforts of those right across DfID, but especially Chris Whitty, Tony Redmond from Manchester and George Turkington and their teams, for their tireless work in tackling this disease.