Ebola Outbreak: Democratic Republic of the Congo

Baroness Northover Excerpts

Monday 20th May 2019 Lords Chamber

[Lord Collins of Highbury (Lab)]

My Lords, I thank the Minister for repeating the Statement and I join her in expressing sympathy for all those who have lost loved ones in this latest Ebola outbreak. It is true—the WHO has said as much—that it is likely to spread into neighbouring countries, which is why this response is so urgent. I welcome the Government’s response and the fact that we are drawing on the expertise and knowledge built up as a result of our intervention in Sierra Leone. I too pay tribute to the DfID staff for their work on this.

However, as David Miliband from the IRC has said, this outbreak is getting worse,

“despite a proven vaccine and treatment”.

Of course, as the Statement acknowledges, one of the major barriers to delivering the response is the breakdown of trust in the affected community. We have heard from agencies on the ground that one of the major difficulties is that the actors involved in the Ebola response are the very same people who have played a long-standing role in the ongoing conflict in the region. In terms of our response, the priority must be to address this issue.

Given that, can the Minister tell us more about how we are building trust with the Congolese community in terms of their accepting the response that is needed? One clear lesson from the west Africa outbreak, particularly in Sierra Leone, was the role of community engagement. All too often it is regarded as being a soft and relatively non-technical add-on to medical interventions. However, I was pleased to hear the Secretary of State in the other place talk about engaging with political leaders to dispel the myth that Ebola is somehow fabricated.

However, we are addressing other barriers as well. Certainly, the mobilisation of the community should be centre stage in our response in ensuring that we are able to help members of the community protect themselves, particularly in terms of safe burial practices and so on. Can the Minister say whether we are able to work with NGOs on building that community response? What plans do we have to directly fund the NGOs currently operating in the affected areas so that they can continue their work?

The point about this response, along with the one in west Africa, is that it is set against a backdrop of chronically poor health and nutrition indicators that further impact negatively on the affected communities. Can the Minister tell us what steps DfID is taking to support the Congolese Government beyond the emergency response? How are we scaling up the nutrition programmes and how will we be able to strengthen the healthcare systems in such a difficult environment?

I hope that the Minister can update us on all of the programmes because while we may be able to halt the spread of Ebola, there is no doubt that if we do not address the fundamental issues of healthcare systems, this issue will keep coming back to haunt us.

[Baroness Northover (LD)]

My Lords, I too thank the Minister for repeating the Statement—a slightly different one from that which is available in the Printed Paper Office. I also thank those who have already responded in person to this incredibly dangerous situation. I cite in particular the ground-breaking work carried out by teams led by the former DfID chief scientific adviser, Chris Whitty, who is also at the London School of Hygiene & Tropical Medicine. Those teams have played an extraordinary part in turning around the epidemic in west Africa.

This situation is indeed extremely worrying. It was difficult and dangerous enough when we were engaged in Sierra Leone during that Ebola outbreak, but this is even more difficult because Ebola has struck in an area of conflict where suspicions are aroused by those who are seeking to help, thus undermining what they are able to do. The WHO has identified the main drivers in the continued rise in the number of cases as stemming from insecurity, poor community acceptance, delayed detection and late presentation. Does the noble Baroness agree that this means that cases staying in the community pose huge risks to members of the community as well as to those who seek to treat them?

The noble Lord, Lord Collins, is right about engaging the community. I note the use of the word “anthropology” in the second, rewritten Statement. That understanding in the west Africa cases led to a very different approach to how you engaged with the community.

Then there is the lack of funding. With inadequate funds coming to tackle the crises in Yemen, Syria and elsewhere, how will we make sure that adequate funds come through to tackle this crisis? Does the Minister note that the International Federation of Red Cross and Red Crescent Societies warns that it has enough funding to continue the safe burials required for only another two weeks, amid a $16 million shortfall and increasing infections? Is it receiving UK funding, and will this increase?

The Statement speaks of needing people “on the ground”. Many extraordinarily brave doctors and nurses from the UK volunteered to assist in Sierra Leone, making a decisive difference. Some, like nurse Pauline Cafferkey, almost paid with their lives. Those who went out were screened and trained, largely by UK-Med at the University of Manchester. Is that happening this time? Valiant efforts were made—for example, at the Royal Free—to support any staff, like Pauline, who succumbed to the disease. What support is being given to Sir Michael Jacobs and his team at the Royal Free if more cases present among British staff or the public?

The Ebola outbreak in west Africa gave a huge and welcome impetus to vaccine development. Could the Minister update us on where we are with this? Is the vaccine to which she referred the one developed at the Jenner Institute at Oxford University and supported by DfID?

UNICEF rightly flags the situation of children affected by the disease, either directly or indirectly when they lose a parent. We are much more aware now about the risks to children who lose their parents. How is this being tackled?

I note the changes between the first and second versions of this Statement, especially on what the UN, WHO and US are doing, with possible input also from the London School of Hygiene. It is exceptionally important that we work with all international and national bodies, as we did in a quite remarkable way in west Africa. In even more difficult circumstances, we need that again. I look forward to hearing the Minister’s response.

[Baroness Goldie]

My Lords, I first thank the noble Lord and the noble Baroness for their sensitive remarks and their clear understanding of the complexities of this very difficult situation with the outbreak in this area of the Democratic Republic of the Congo. I will try to deal with the points raised.

The noble Lord, Lord Collins, rightly said that community engagement is important, and I absolutely agree. He also asked about healthcare programmes and what progress we are making in that respect. On the whole issue of community engagement and trying to understand better what the challenges are, I understand that my right honourable friend the Secretary of State plans to visit North Kivu shortly to understand the situation on the ground and to consider how the UK can continue to support the response.

I assure both the noble Lord and the noble Baroness that the current Ebola outbreak in the DRC is an immediate priority for the Department for International Development. We have dedicated teams leading a co-ordinated UK HM Government response effort. As I indicated in the repeat of the Statement, the UK is one of the leading donors to the response in the DRC and the leading donor in preparedness efforts in the region.

The noble Baroness, Lady Northover, pointed out the huge risk not just to communities but to those endeavouring to help deal with the outbreak. She rightly said that how one engages with communities is very important, and I totally agree. As I have indicated to the noble Lord, Lord Collins, the Secretary of State proposes a visit, and I think that will be extremely helpful.

I may have misled noble Lords in referring to my right honourable friend the Secretary of State; it might be the Minister for Africa who is making the visit. I am reading from a variety of papers here. As the noble Baroness, Lady Northover, indicated, even trying to update the Statement to the version actually delivered in the other place was challenging. It is in fact the Minister for Africa who proposes to visit.

The noble Baroness, Lady Northover, raised the vaccine. The Merck vaccine is being deployed under experimental protocol using ring vaccination. This vaccine has been shown to be highly effective in a trial in Guinea. The Statement indicated that modelling by Yale suggests that the vaccine has reduced the scale of the outbreak by 70%. The noble Baroness asked me something specific about the background to the vaccination; I do not have an answer, but I will undertake to try to obtain more information about that. I understand that there are plans to trial another experimental vaccine outside the current outbreak area, including in key locations such as Goma.

I was also asked about what exactly the UK is doing in terms of experts. We have a UK public health rapid support team, and technical experts including senior epidemiologists, data scientists and a clinical trial specialist have been deployed to eastern DRC. The PHRS team—the rapid support team—has played a major role in supporting preparations for clinical trials of new therapeutic drugs currently being administered to patients.

I think I have managed to answer the main points raised. If I have missed anything out, I shall certainly write to the noble Baroness and the noble Lord.