Ebola

Justine Greening Excerpts

Thursday 12th March 2015 Commons Chamber

[The Secretary of State for International Development (Justine Greening)]

With permission, Mr. Speaker, I would like to update the House on the Ebola outbreak in west Africa. First, I refer the House to yesterday’s statement from Public Health England, which confirmed that a military health care worker has tested positive and is being flown back, and will shortly be in the Royal Free hospital in London. Our thoughts are with her and her family at this time. We are also assessing four other military health care workers who had been in close contact with the patient. That is a purely precautionary move.

Our armed forces, our health workers, our diplomatic staff and my development staff are risking their lives to help Sierra Leone defeat this terrible disease and stop it spreading beyond west Africa. It is vital that we do that. Halting the rise of the disease in west Africa is by far the most effective way of preventing Ebola from infecting people in the UK. We are indebted to those UK personnel for their efforts; their commitment and bravery, which I have had the chance to see at first hand, have been outstanding.

As the Secretary of State for Health has said previously, the UK remains well placed to respond to this threat. The chief medical officer confirms that the risk to the UK remains low. An enormous amount of work has gone into making sure that we are prepared in the UK, now and in the future. The NHS has world-leading infection control procedures, and we have put in place robust screening and monitoring arrangements to detect and isolate cases at home.

A few weeks ago, I returned from my third visit to Sierra Leone in five months. In that time, there have been significant improvements. The number of cases per week has reduced from well over 500 in November to fewer than 60 now. Our strategy is working, and President Koroma and others have thanked the UK Government and the UK public for our critical and unwavering support. I am extremely proud that Britain’s support means that there are now enough Ebola beds, testing labs and trained burial teams, and an effective command and control structure to track down the disease across Sierra Leone and prevent it from spreading further.

The challenge now is to get to zero cases as quickly as possible. That will not be easy—we are looking at months, not weeks, till the end of this crisis—but we have the right people and the right plan in place to deal with this. The UK will continue to provide critical support to this response, particularly in the health sector, through which we will help Sierra Leone to tackle future disease outbreaks. We will hold our nerve and stay the course. This ongoing package of support will bring our total commitment to this response and to the country’s early recovery to £427 million.

The UK response will change as we transition to the next phase. After the best part of six months on station, RFA Argus will sail by the end of this month, as previously planned, having provided critical support to military and civilian volunteers on the ground. We will maintain the health care capabilities that it has provided through continued UK military support at an enhanced Ministry of Defence clinic in Freetown. The helicopter capabilities will be replaced by commercial providers. Military personnel will also continue to play an important role at the dedicated Kerry Town Ebola treatment facility for health care workers, and in supporting our Sierra Leonean partners with command and control to respond to district-level outbreaks.

Although the last planned deployment of NHS staff is due to end this month, we are mindful of further spikes in the case load. To that end, we have arranged for an NHS stand-by team to be on call to deploy within 48 hours. Throughout this response, the co-operation of the NHS, NHS trusts and Public Health England has been tremendous, both in Sierra Leone and at home, and for that I give them my heartfelt thanks. More than 150 NHS staff have so far been deployed to fight Ebola, which is testament to the superb flexibility of its staff at all levels. Our support for labs, through Public Health England, will continue, as testing capacity is vital to the continued effort.

We are also planning for recovery. The Ebola crisis has disrupted markets and access to food and other essentials for many families. It has put an enormous strain on the country’s health care system, and it has caused a generation of children to miss nearly a year of school. For too many children, the Ebola crisis has resulted in a breakdown of family and community protection systems. More than 9,000 children are registered as having lost one or both parents in this crisis, and they are vulnerable to neglect, abuse and exploitation.

Continued leadership from the Governments in the region will be crucial to maintain the momentum. I welcome President Koroma’s leadership, and his clear message that there can be no half-victories. We will work with the Government of Sierra Leone to reopen schools and hospitals safely, and ensure that those most at risk of stigma, including orphans, have the support that they need.

Throughout the response, we have received critical support from international partners to help us staff treatment centres and labs across the country. I was in Brussels last week to ensure that the international community remains engaged in defeating Ebola, and in helping Sierra Leone and the countries of the region back on to a path to sustainable recovery.

The international community must also learn lessons from this outbreak and, together with the Governments of the affected countries, build a more resilient system for the future. We must do everything that we can to ensure that a crisis of this nature never happens again.

In conclusion, the UK did not stand on the sidelines when Sierra Leone needed us, and our strategy has saved thousands of lives and protected millions more around the world. That response, though far from over, has shown the very best of what the UK can do overseas. I am incredibly proud of the way that we have stepped up to this challenge and delivered in the toughest of circumstances. I am pleased to confirm that Her Majesty has agreed to honour this tremendous effort with the striking of a medal. I commend this statement to the House.

[Mary Creagh (Wakefield) (Lab)]

I thank the Secretary of State for giving me a copy of her statement in advance, and for advance warning of the statement. I join her in paying tribute to the military health care worker who has tested positive for Ebola. We wish her a speedy and full recovery. Our thoughts are with her and her family and friends. I am sure that the good wishes of the whole House are with her as she returns home to Britain.

The Secretary of State mentioned four other military health care workers who are being assessed. Are they also being flown home to Britain and, if so, in which hospitals will they be assessed? We also pay tribute to the dedication and bravery of the British troops, health workers, charity workers and Department for International Development personnel who have travelled to west Africa to tackle Ebola. They have selflessly put themselves on the front line against this disease. We thank them for their work and salute their courage.

Labour continues to support the Government’s efforts to tackle Ebola and get to zero cases as soon as possible. We agree with the Public Accounts Committee that the Department should take a lead role in global efforts to reach that target. The Ebola outbreak has been devastating for the people of Sierra Leone, Liberia and Guinea. There have been more than 24,000 reported cases, and nearly 10,000 deaths. More than 20,000 children are now orphans; they are vulnerable, traumatised and often stigmatised. We welcome what the Secretary of State has said about tackling the stigma of Ebola and services for Ebola orphans. Will the Government ensure that their Ebola response prioritises long-lasting psycho-social and child protection services and the education sector in Sierra Leone?

Ebola has revealed the problems that are created when countries do not have sustainable and resilient health systems. It has shown the limitations of the global community’s approach to health care in developing countries. It has triggered a huge debate on how we should reform the World Health Organisation so that it meets disease challenges better.

Save the Children’s report last week found that 28 countries had worse health coverage than Liberia had at the start of the Ebola outbreak. The world today is globalised; disease outbreaks are everyone’s concern, and preventing them is in everyone’s interests. Can the Secretary of State tell the House how much of the £427 million that the UK Government have committed to fighting Ebola has been disbursed? The previous figure that she mentioned was £325 million. What will the extra £100 million be spent on?

The Secretary of State mentioned a contract with civilian helicopter providers. How much will that cost each month, and for how long will the contract continue? What steps has she taken to persuade other countries to fill the urgent $400 million funding gap for immediate response, and the $900 million gap identified by the United Nations for activities over the next six months? What conversations has she had with her ministerial colleagues about restoring direct flights from the United Kingdom to Sierra Leone, and when will they begin operating again?

Our NHS has shown that the best way to protect against disease is to build a resilient, Government-controlled, Government-funded health service, so how much bilateral funding will the UK give to support the Sierra Leonean and Liberian health sectors next year? How will the Secretary of State and her Department lead reform of the global health system to move organisations away from concentrating on specific diseases and vaccines to a much broader focus on supporting public health systems?

The global community must never again find itself with another Ebola outbreak, no vaccine to prevent spread, and no treatment to preserve life. At the last DFID questions, I asked the Secretary of State if she agreed that we needed urgently to roll out the Ebola vaccine trials from Liberia to Sierra Leone and Guinea to discover which vaccines work. Have those trials started, and if so, how many people are enrolled in them? What conversations has she had with the World Health Organisation about treatment trials?

There is consensus that the global community failed to respond adequately to this Ebola outbreak. As the Secretary of State rightly said, we need to learn the lessons and ensure that we are better prepared. Lasting health care systems are about more than the delivery of commodities such as vaccines and bed nets, vital though those things are. The WHO, the World Bank and non-governmental organisations in countries such as France and Japan are all clear that universal health coverage is the right answer. Does she agree that that is the way forward?

[Justine Greening]

The hon. Lady asked, understandably, about the four other health care workers. They are now in the process of being flown home, purely on a precautionary basis, and will be dealt with at the Royal Free hospital and the Royal Victoria infirmary in Newcastle.

I had a chance to meet some of the orphans from this crisis when I was in Sierra Leone just before Christmas. They were of all ages, of course. Some of our work is to help UNICEF to provide the psycho-social support that they need and to keep the orphanages going. We are also helping to provide dedicated centres where children can be looked after safely if their parents go to community care centres to be tested because they are concerned that they have Ebola; if the parents end up being taken into care, they cannot look after their children.

There are huge child protection issues. I can reassure the hon. Lady that we are mindful of them, and mindful of the need to work not just with the Government of Sierra Leone but with civil society and the NGO sector to make sure that they are properly addressed.

The hon. Lady asks about the extent of our commitment. The £427 million that I have talked about is essentially the money that we are spending on providing ongoing support, including what we have already done, which has now cost more than £200 million. Over the coming months, we need to keep supporting the beds and the safe burials and all the very practical work that we are doing—social mobilisation, talking to communities—and also put in place a budget, which is about half the increase, for the initial planning on early recovery. We are steadily shifting our strategy to ensure that we have the capacity on the ground still to cope and deal with Ebola and get to zero. That is the principal objective that we have to meet, while transitioning to look at how we can safely open schools and hospitals and deal with some of the issues that the hon. Lady talks about in relation to communities.

The helicopter support has been absolutely vital. The road network is part of the development progress, but there is no doubt that fantastic work has been done by the Merlin helicopters. I had a chance during my trips to Sierra Leone to get to know some of the pilots—I was there regularly enough—and they have been working round the clock. I want personally to say a massive thank you to them. They were incredibly impressive and have really put in the flying hours over the past six months. The civilian helicopter provision will ensure that we can continue to get around Sierra Leone rapidly and that the district-level response is working effectively, which is why we have kept it in place.

On the important point about ensuring that, frankly, we get the international community to step up to the plate, particularly as recovery takes place, we are indeed investing a lot of time and effort in lobbying. The Brussels conference, which happened a couple of weeks ago, was absolutely key in really making sure that we got international focus on the need to get to zero, avoiding complacency and starting to present the forward look at what those recovery plans will need. The $400 million part is really the initial absolute priority investment that is required to start the recovery process and kick it off. There will be a follow-up conference at the UN, which will be more focused on pledging. We have worked directly with the Government of Sierra Leone to talk to them about how we can ensure that their recovery plan is of good quality and essentially investable and prioritised, and we will continue to do all that work.

The hon. Lady also asks about the Ebola vaccine trials. In fact, we had some vaccines ready to go for phase 2 trials because the UK and DFID had already worked with the Medical Research Council and Glaxo Wellcome to help to support Ebola vaccines in the phase 1 trials. One of the learnings from my perspective is being clearer as an international community about what kinds of vaccine we want to have in stock at phase 1 stage, in order to be able to put them rapidly into phase 2, which is more expensive, if crisis hits. Also, streamlining the regulatory procedures is important, so that we can get the vaccines tested more rapidly when there is a real public health crisis element to them. Obviously, we all appreciate that the regulatory environment is there for a reason, which is to protect patients, but in this case, it was vital that we looked at how we could fast-track the Ebola vaccines. The trials have started in Liberia already. They are about to be started in Sierra Leone and Guinea.

On the number of patients, if anything we have a challenge, because fewer people are suffering from Ebola, but as the hon. Lady will understand, that is the patient population on whom we are testing the vaccines.

On WHO reform, I have had a chance now on a number of occasions to see Margaret Chan, both in London and, most recently, in Brussels. The UK has been a leading player, most recently in the special session on WHO reform, playing a constructive a role in helping us all to learn about how not only the WHO but the international community can better respond to such a public health crisis in the future.

[Jeremy Lefroy (Stafford) (Con)]

I join the Secretary of State and the shadow Secretary of State in paying tribute to all those who have tackled this terrible disease, some losing their lives in doing so—Sierra Leoneans, Liberians, Guineans and all others, including the British workers. I pay tribute, too, to the Secretary of State for the leadership that she has shown in this crisis. In a video conference which I chaired last month with the president of the World Bank and parliamentarians from affected countries, all stressed the need, which the shadow Secretary of State mentioned, to strengthen health systems. We also talked about the possibility of doing stress tests of those health systems, in the way that has been modelled for the banking sector, to ensure that they are robust enough. Parliamentarians all agreed on this vital point. Can my right hon. Friend assure me that the United Kingdom will continue to work with Sierra Leone and the Governments of the other affected countries over the coming months and years, and ensure that we do not leave them at this time of need?

[Justine Greening]

Yes, I can. The Ebola crisis has shown why the work that we do in development is so important. We saw that countries in parts of west Africa that had better developed health care systems were able to withstand this unprecedented Ebola outbreak. However, in the case of Sierra Leone and Liberia particularly, which had experienced terrible civil wars and comparatively recently come out of them, although their health systems had dramatically improved, they were still at a nascent stage and were unable to withstand such an unprecedented outbreak. I can assure my hon. Friend that the UK will play a leading role, particularly in our relationship with Sierra Leone, which is unique.

I join my hon. Friend in paying tribute to the bravery of the Sierra Leonean community, who were the ones on the front line, many of them volunteers, who ran towards the crisis and were part of the effort to tackle it, at the very time when most people would have wanted to run in the opposite direction. They were overwhelmingly the ones who helped get the crisis under control, but I am proud of the UK effort in supporting that.

[Glenda Jackson (Hampstead and Kilburn) (Lab)]

I thank the right hon. Lady for her statement, affording the House the opportunity to say thank you and to pay tribute to all those who have played their part in tackling this appalling disease, not least the staff of the isolation unit in the Royal Free hospital in my constituency and everyone in that hospital. I was delighted to hear that the Secretary of State is prioritising the next great step that will be needed—the restoration of health services in the countries affected—and addressing the issue of orphans. I welcome her commitment to working with the international community on these issues. Will she also commit to ensuring that all the voluntary agencies, NGOs and charities begin to work together rather more positively than they have done in the past?

[Justine Greening]

The Royal Free hospital has provided world-class treatment for the patients whom it has looked after, and I pay tribute to it. On the restoration of health services, it is important that there is a Government-owned strategy in Sierra Leone on health care priorities. Perhaps some of the most pressing priorities right now are malaria—we are about to enter another rainy season, which is a high risk—getting vaccinations back up to combat diseases such as measles, and maternal health, making sure that women are able to give birth safely.

I had a chance to visit a hospital that just about managed to keep going through the crisis, but we know that teenage pregnancy, which is partly due to the fact that children have been out of school, has been a huge problem that will need to be addressed. It is important that the NGO community works as part of that overall Government of Sierra Leone-owned health care strategy and we will play our part in helping to deliver it. It has to focus on some short-term imperative deliverables and look at the longer term. That includes making sure that the Ministry of Health in Sierra Leone has the capacity to continue to develop policy.

[Sir Nick Harvey (North Devon) (LD)]

I welcome the statement, commend the work of all those combating the crisis, and echo the good wishes to the British military in its work of flying personnel home for emergency treatment at the Royal Free hospital. The Secretary of State mentioned the figure of 12,000 orphans created during the crisis, which is probably a vast underestimate, particularly in the rural areas. There will be so much to do afterwards—getting the health system and the transport links sorted and getting the economy going again—but can we make a particular commitment from the UK to help clear up the profound legacy that those orphans will represent?

[Justine Greening]

I can reassure my hon. Friend that we are already working on that alongside prioritising work to get health care systems back up and running. Interestingly, as part of the response, we have had to improve water, sanitation and hand-washing. We now hope that some of the health care workers whom we trained to be part of the response who were originally teachers can take that into schools, so that as children get back into school we can keep embedded those positive behaviours that are good for health.

[Paul Flynn (Newport West) (Lab)]

The magnificent courage and professionalism of all those involved have earned the gratitude and admiration of all of us, and that includes the work of the Secretary of State herself. Are not the lessons that we must persuade the World Health Organisation to move away from its dominance by commercial interests and reshape our armed forces to concentrate on what we do so well in these humanitarian situations? The challenges in future will be more diseases; the need for clean water; all the impact of global warming. Should we not concentrate on a future not of warring tribes among the nations, but of one human family, which is in deadly peril?

[Justine Greening]

I am grateful for that wide-ranging question. The hon. Gentleman is right to say that what we have learned from this crisis is not to see problems such as Ebola as someone else’s. They are absolutely relevant to us. We can fly from that part of west Africa to the UK in under six hours. He talked about this new model of development, if I can call it that, particularly in response to humanitarian crises: the work that DFID has done with critical support from the Ministry of Defence and the NHS. This triumvirate departmental response shows that the Department can bring to bear a much broader UK offer in responding to these crises in future than we have ever been able to do in the past. I pay tribute to the willingness of both the Department of Health and the MOD in working with DFID. It is a fantastic working relationship, which has gone from strength to strength.

The hon. Gentleman also talked about the role of the private sector in global health security and the WHO. Some of the lessons that we are learning are as much about the WHO’s command and control, and its ability to drive projects from the centre down into the regions, but there is no doubt in my mind that the private sector does have a key role to play, particularly given some of the important ways in which we might more significantly combat Ebola, for example through the development of a vaccine. The key is to find the right role for the private sector. In my previous answer I referred to sanitation and hand-washing, and clearly companies such as Unilever have long played a role in helping to educate the public.

[Mr Speaker]

These are extremely important and sensitive matters, but we have a heavily subscribed defence debate, to which I wish to move without delay.

[Mr James Gray (North Wiltshire) (Con)]

The contribution made by the armed services, 750 of them, the Royal Fleet Auxiliary Argus and the Merlin helicopters, has been superb, and it would not have been possible to battle against Ebola in this way without them. I look forward to welcoming them back here to Parliament in the autumn perhaps. In the meantime, does the Secretary of State, or perhaps the Minister for the Armed Forces who is sitting next to her, agree that if we were to see unwelcome defence cuts, such operations in the future and elsewhere in the world would not be possible?

[Justine Greening]

This case shows that the work of the MOD is intrinsically linked to the work on development. We need to see the UK foreign affairs strategy in the round and to be prepared to look at it in that light.

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

The right hon. Lady says that she will hold her nerve, stay the course and support the recovery of health services, but House of Commons Library figures show that she cut health care support to Sierra Leone and Liberia by more than £10 million during this Parliament, only for the Prime Minister to have to top it up by £80 million to deal with the crisis. Does she not need to admit that that is evidence of poor judgment on her part, rather than evidence of her holding her nerve and staying the course?

[Justine Greening]

Since 2010 the UK has spent a total of £64 million in the health sector in Sierra Leone, compared with a total of £23 million spent between 2005 and 2010 under the previous Government. I think that a more constructive approach in this sort of discussion is more productive.

[Jim Shannon (Strangford) (DUP)]

A significant number of the service personnel serving in west Africa are from Northern Ireland. Obviously their families and loved ones want them to return safe and healthy. I understand that the incubation period for Ebola can be up to a month. What steps is the Secretary of State taking to ensure that a quarantine period is initiated?

--- Later in debate ---

[Justine Greening]

As the hon. Gentleman will be aware, we have to follow Public Health England’s guidelines. Our duty of care to all the people involved in the UK response is obviously a top priority.

[Mr Speaker]

I am extremely grateful to the Secretary of State and to colleagues for their helpful co-operation.