UK Response to the Ebola Outbreak in West Africa

Lord Bourne of Aberystwyth Excerpts

Thursday 12th March 2015 Lords Chamber

[Lord Bourne of Aberystwyth (Con)]

My Lords, with the leave of the House I will now repeat a Statement given in the other place by my right honourable friend the Secretary of State for International Development. The Statement is as follows.

“With permission, Mr Speaker, I would like to update the House on the Ebola outbreak in west Africa.

First, I would like to refer the House to yesterday’s statement from Public Health England which confirmed that a military healthcare 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 healthcare workers who had been in close contact with the patient. This is a purely precautionary move.

Our Armed Forces, our health workers, our diplomatic 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 vitally important that we do that. Halting the rise of the disease in west Africa is by far the most effective way of preventing Ebola infecting people in the United Kingdom, and we are indebted to those United Kingdom personnel for their efforts. Their commitment and their bravery have been outstanding.

As my right honourable friend the Member for South West Surrey has said previously, the UK remains well placed to respond to this threat. The Chief Medical Officer confirms that the risk to the United Kingdom remains low. An enormous amount of work has gone into making sure we are prepared in the United Kingdom 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 less than 60 now. Our strategy is working, and President Koroma and others have thanked the United Kingdom Government and the United Kingdom public for their critical and unwavering support.

I am extremely proud that Britain’s support means there are now enough Ebola beds, testing labs, trained burial teams and an effective command and control structure to track down the disease across Sierra Leone and stop it spreading further. The challenge now is to get to zero cases as quickly as possible. That is not going to 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 United Kingdom will continue to provide critical support to this response, particularly in the health sector, where we will help Sierra Leone tackle future disease outbreaks. We will hold our nerve and stay the course. This ongoing package of support will now bring our total commitment to this response and the country’s early recovery to £427 million.

The United Kingdom response will change as we transition into the next phase. After six months on station, RFA “Argus” will sail as previously planned by the end of this month, having provided critical support to military and civilian volunteers on the ground. We will maintain the healthcare capabilities she has provided through continued United Kingdom military support at an enhanced MoD clinic in Freetown. Her 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 healthcare 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 this end we have arranged for an NHS standby team to be on call to deploy within 48 hours. Throughout this response the co-operation of the NHS, the NHS trusts and Public Health England has been tremendous, both in Sierra Leone and at home. Over 150 NHS staff have so far been deployed to fight Ebola. That is testament to the superb flexibility of its staff at all levels. Our support through Public Health England on labs 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 healthcare 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. Over 9,000 children are registered as having lost one or both parents in this crisis. 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 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—first to defeat Ebola, and then to help 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 United Kingdom 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. This response, though far from over, has shown the very best of what the United Kingdom 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. And so 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”.

[Lord Collins of Highbury (Lab)]

My Lords, I thank the Minister for repeating the Statement. My thoughts today, and I believe those of all noble Lords, will be with the military healthcare worker who has tested positive for Ebola, wishing her a speedy recovery as she returns to Britain. Our thoughts go also to her family and friends at this stressful time. I understand from the discussion in the other place that the four other personnel who may have come into contact are also being flown home, and we wish them well, too.

As a nation, we can be incredibly proud of the dedication and bravery of the British troops, health workers and charity workers who have travelled to west Africa to tackle Ebola. We on this side continue to support the Government’s efforts to tackle Ebola and get to zero cases as soon as possible. This outbreak has seen 24,000 reported cases and nearly 10,000 deaths. As the Minister said, over 20,000 children are now orphans—vulnerable, traumatised and often stigmatised. However, Professor Chris Whitty, chief scientific adviser to DfID, said:

“There is a high chance that when we look back on this epidemic more people who did not have Ebola will have died as a result of the Ebola epidemic”.

The Government rightly identify defeating Ebola as quickly as possible as the most important step in giving Sierra Leone the best chance of successful reconstruction and development in the long term. It is also right to be planning for that long term now. It is imperative that, once the immediate crisis is over, the eyes of the world do not turn away from that region. In December, the International Development Committee of the other place recommended that DfID convene a global conference in early 2015 to agree a common plan for post-crisis reconstruction in the region. What progress has been made on this recommendation? Also, what is the Minister’s assessment of how well prepared for Ebola the neighbouring countries are? What plans does DfID have to scale up work in Guinea, which today threatens to compromise progress in Sierra Leone and Liberia?

The outbreak has shown the limitations of the global community’s approach to healthcare in developing countries—and, as the Minister said, it has triggered a huge debate on reform of the WHO and whether it is fit for purpose. Will the Minister tell the House what practical steps the department has taken in pressing for a review of the international approach to health emergencies, incorporating the function, structure and funding of the WHO and the role and expectations of major donors? It is the view of the International Development Committee that DfID should not wait until its 2015 multilateral aid review to do this; it believes—in my view, quite rightly—that the urgency of the situation warrants immediate action.

This crisis underscores the importance of investing in a strong system of research and development for global health. As Justine Greening said:

“The development of new technologies is vital if we are to improve the health of the poorest people through better treatment and prevention”.

Will the Minister commit to prioritising within DfID, and promoting among other key donors, the need properly to fund and support research and development for global health? In the development of vaccines and therapeutic drugs, we have a broken market. The cost of bringing forward a drug or vaccine and taking it through the necessary regulatory process means that pharmaceutical companies prefer to focus on diseases in affluent markets rather than diseases such as Ebola and TB which affect the poorest and most vulnerable. Will the Minister support within government the recommendation from the HIV/AIDS APPG that the UK commissions an economic paper to contrast the total costs of developing and purchasing medical tools using the current R&D model with the costs of a delinked model?

The best way to protect against disease is to build a resilient, government-controlled and government-funded health service. Will the Minister tell the House how much bilateral funding the UK will give to support the health sectors of Sierra Leone and Liberia next year to rebuild community trust?

There is a consensus that the global community failed to respond adequately to this outbreak. We need to learn the lessons and ensure that we are better prepared. Does the Minister accept that this reinforces the case for universal healthcare systems, free at the point of access, and that we should use this language in a stand-alone health goal in the forthcoming UN negotiations on the SDGs? Building robust, fair and accessible health systems is ultimately a political decision. Does the Minister agree that we must work with leaders in developing countries and help them generate adequate funding themselves as well as from donors to build better health systems that ensure that no one is left behind?

[Lord Bourne of Aberystwyth]

My Lords, I thank the noble Lord for his general support and for the bilateral approach that we adopt on these occasions.

I shall first update the House on the position of the healthcare worker who is now back in the United Kingdom. Indeed, I think that by now she is in the Royal Free Hospital. Our thoughts are with her and her family and friends. On that flight, there were two other healthcare workers who, I think, are also in the Royal Free Hospital as a precautionary measure. There are two other health workers who are being monitored in Sierra Leone as a precautionary measure, and they may be flown back to the United Kingdom. That is, as I understand it, the current position, and our thoughts are very much with them and their families and friends.

The noble Lord spoke about the need to ensure that the healthcare system in Sierra Leone recovers on the other side of this crisis. Work is under way to ensure that that happens. He referred to loss of life from things other than Ebola, which is the case. We are approaching the rainy season, when malaria will be a threat. Measles vaccination is also vital as are maternity care and so on. There has been loss of life from many other causes, which is why the period of recovery—on the other side of this dreadful disease—is important. It remains the aim to get to zero and that is clearly the right approach, but the other side of this is a recovery phase for the health service and education. Of the £100 million increase in the budget figures—there was mention of £427 million; it is actually up from £325 million —half will be spent on the recovery phase, so that will be going into the healthcare and education sectors to meet the other health problems and emergencies that the noble Lord quite rightly referred to.

The noble Lord also raised the issue of vaccines and the healthcare measures taken via the private sector. Work is under way via GlaxoSmithKline, which has been trialling a vaccine in Liberia. That is going well and trials will be started in Sierra Leone. To that, the Government have committed, I believe, £2 million, which has not been drawn down as yet. As I said, the overall position is one of steady progress. I will not call it a problem—of course, we want zero cases—but the fewer cases there are, the more difficult it becomes in a sense to trial the vaccine on patients. As the noble Lord said, vaccines and trials are clearly important.

The noble Lord spoke of the importance of a universal healthcare system and I certainly agree with that. It is something that we are very focused on. As I think the Statement of my right honourable friend the Secretary of State in another place made clear, our commitment will go on beyond the point where the cases are down to zero. It is a continuing commitment.

Regarding the other two states that the noble Lord mentioned, Liberia has chiefly been getting United States support and Guinea French support. For historical reasons perhaps and reasons of inextricable ties with Sierra Leone, our support has been focused on Sierra Leone, but success is dependent on getting support across all the countries. We are seeking to do that both through collaboration with our partner countries in those two states and through the WHO.

The noble Lord will be aware that the Prime Minister, at the G20 in Brisbane in November last year, spoke about how important it was that we have an early mechanism through the World Health Organization for dealing with health emergencies and being on the front foot. The WHO accepted that in its January meeting and it will carry that forward. We will be watching and continuing to press to make sure that we have that early response because, as the noble Lord rightly identified, it is key to dealing with this sort of crisis.

[Lord Chidgey (LD)]

My Lords, first, I express the concerns from these Benches for the welfare of the young military healthcare worker who is now in the Royal Free Hospital. Our thoughts, too, are of course with her family at this time.

We commend the dedication, the skill and the bravery of the UK Armed Forces personnel who have been in Sierra Leone and of course the NHS volunteers who have accompanied them. We also commend the work of the Save the Children organisation and other funds in caring for more than 9,000 orphan children, protecting them from neglect, abuse and exploitation.

The recent renewed outbreak of Ebola cases around Freetown is a clear warning that this crisis is far from over. Does my noble friend agree that much more needs to be done to tackle the root of the problem, which is generally accepted to be the almost non-existent primary healthcare in the very remote and inaccessible mountainous forest region on the Guinea/Sierra Leone border? To put this in perspective, the border is a transient thing through the middle of forests and over mountains. The people who live in the remote villages there do not necessarily recognise the border; they recognise their neighbours, who may be living, by definition, in a different country. The people living in these very remote and relatively primitive villages rely almost entirely on traditional healers when they fall ill. This is a group of people, by the way, who have suffered a tremendous number of casualties in their attempts to help their fellow villagers.

What action is the United Kingdom taking to assist our French counterparts, who, as the Minister pointed out, have taken some responsibility to work with the Guinean authorities to try to tackle the problem? They are faced, as are the Guineans, with the task of containing Ebola in extreme circumstances almost beyond imagination. I look forward to the Minister’s response.

[Lord Bourne of Aberystwyth]

My Lords, I thank my noble friend for his kind words in relation to the United Kingdom public sector workers, both in defence and the National Health Service. They are a matter of great pride for the Government and the whole country. He is right, there are a substantial number of volunteers in Sierra Leone who have gone out from the United Kingdom—more than 130 since the crisis started—and many more are on the public register indicating a willingness to help and to serve there. It is remarkable. We should be proud of this; it is totally humbling.

As the noble Lord said, we must not become complacent about the situation. It is true that it is improving but there will be spikes along the way. We must work hard at reducing the number of cases to zero.

The noble Lord referred to the root of the problem. It is true, again, as he has indicated, that healthcare, particularly in the rural parts of Sierra Leone, is not what one would want and clearly has to be addressed. Ironically, there had been considerable improvements in the healthcare system in Sierra Leone over the decade prior to this outbreak. Life expectancy had increased quite massively, maternity care was better and so on. We must get back that momentum, go beyond it and work with our partners in other countries, as he indicated.

The noble Lord also referred to old practices, which is certainly true in healthcare and true in burials, which have been a particular problem. It is a matter that we have had to address because many of the deaths have stemmed from unacceptable practices in relation to burials.

[Baroness Masham of Ilton (CB)]

My Lords, does the Minister agree that the countries affected by Ebola need to be educated not to eat bush meat, such as that of fruit bats? Should there not be better sewerage works and clean water in the towns and villages? I am pleased to hear that religious leaders seem to have got together over Ebola, which must be a good thing.

Prevention of such terrible infections must surely be the priority in the long term. I congratulate the specialised team at the Royal Free Hospital on its work and send it and its patients our best wishes.

[Lord Bourne of Aberystwyth]

My Lords, I thank the noble Baroness. Clearly, education is vital. As I indicated through the Statement, traditional education has been at a standstill for most children for a year but learning materials and mobile libraries have helped to stem some of the problems. Teachers, meanwhile, have been tasked with ensuring that messages go out about safe practices, health, sanitation and so on. I hope that will help. I thank the noble Baroness for her constructive comments.

[Baroness Smith of Basildon (Lab)]

My Lords, we should acknowledge that all military and civilian healthcare workers and volunteers who have travelled to Sierra Leone to work in healthcare during the Ebola crisis know that, despite all the precautions, they are placing themselves at risk. That should be acknowledged and I pay tribute to their bravery and the work that they do.

Does the Minister recall that previously—I think it was towards the end of last year—when healthcare workers returned home from Sierra Leone, they complained that the checks that were undertaken on arrival were inadequate and could have placed them and others at risk? It was not that the identified checks that should have taken place were wrong but that protocols were not followed at the time. For example, they were advised that they could travel home by public transport but then not travel on public transport for the next month. That is clearly inadequate and I hope that the Government have had the opportunity to review those protocols. Can the Minister update the House on the arrangements that have been made for healthcare workers and volunteers who return home to ensure that they are properly checked and treated appropriately?

[Lord Bourne of Aberystwyth]

I thank the noble Baroness for her comments and totally agree with her points about bravery, as I have indicated. On screening passengers arriving from affected countries, she will know that the regular direct service between Sierra Leone and the United Kingdom has been suspended sine die, which I am sure is appropriate. We have enhanced the screening in place at Heathrow, Gatwick, Birmingham and Manchester airports, and at the St Pancras Eurostar service, where the vast majority of people travelling from affected areas arrive. No screening procedure will be able to identify 100% of the people arriving, but we are confident that the measures we have come close to that, and we obviously keep them under review.

[Lord Fowler (Con)]

My Lords, we obviously all join the Minister in hoping for the recovery of the healthcare worker and in his tribute to everyone from the UK working in Sierra Leone, who work in some danger to their own health. But is not the crucial part of the Statement that he has just made the aspiration to build a more resilient health system for the future? Are there not too many health systems in Africa that are simply not fit for purpose and which do not serve the public in those countries adequately? This week, we made a very important decision on development aid, on an all-party basis, but I wonder whether the next step should not be to devote even more resources in that development budget to improving healthcare around the world, particularly in these countries. Is that a message that he can take back to the department?

[Lord Bourne of Aberystwyth]

My Lords, my noble friend is correct. Clearly, the most immediate aim is to ensure that we get the number of cases down to zero. That is in sight, although it will take months not weeks. Beyond that, the aim is to build a resilient healthcare system for the future in Sierra Leone. There is the personal commitment of the Secretary of State to that and an ongoing commitment from the Government to Sierra Leone. Beyond that, I very much hope that this can be an object lesson for the future in how to achieve that in Africa and, indeed, globally. I will certainly take that message back. It is something we should all cherish and aim for.

[Lord Purvis of Tweed (LD)]

My Lords, I, too, endorse the comments from Peers across the Chamber in support of UK emergency health workers and our Armed Forces, who, in the face of the challenging incidence of this preventable condition, are supporting the health service in Guinea and Sierra Leone. However, to some extent, this pales into insignificance compared to the pressure on the local health workers in these countries. I follow on from the question asked by the noble Lord, Lord Collins of Highbury, and strongly endorse my noble friend Lord Fowler, in asking about the recommendation in the eighth report of the International Development Committee in another place of a spring conference to consider putting a legacy in place. The Government’s response was that they were going to take part actively in the conference scheduled for last week by the EU, the African Union and the United Nations Secretary-General on forward planning and legacy. If my noble friend cannot update the House today on the conclusions of that conference, will he be able to present an update to the Library of the House so that all Members can be clear as to what the legacy and the UK’s leadership role will be in the future?

[Lord Bourne of Aberystwyth]

First, my noble friend is absolutely right to pay tribute, too, to the local health workers from Sierra Leone, who obviously face the same dangers and are working tirelessly, as are our own public servants, to deal with this tragic emergency. I shall update noble Lords on the position on the spring conference. At the Brussels conference, which was referred to in the Statement, the Secretary of State again ensured that the international message is going out loud and clear. The World Health Organization has its annual meeting in May, which is another crucial date for making sure that the forward planning for dealing with such situations in future is in place. Further to that, I will respond in writing to the specific question that my noble friend asked and ensure that a copy is placed in the Library.

[Baroness Thornton (Lab)]

My Lords, the Royal Free is my local hospital so I am absolutely sure that people will be receiving the best possible care and attention. I am rather proud that my local hospital is providing this service. I want to ask the Minister about building the resilience of local communities in Sierra Leone and to mention in particular and pay credit to an organisation called Restless Development. It specifically recruits young people on the ground to work in their local communities and has been doing it for some time. When the Ebola epidemic happened in Sierra Leone it called together its volunteers. It now has more than 1,700 young people working on the ground in Sierra Leone in more than 7,000 communities. Their job is to work with those communities to trigger those communities to react to protect themselves and to do so within their own resources. I commend the work of Restless Development and I hope that the British Government will continue their support for it, which has allowed it to do this very good work.

[Lord Bourne of Aberystwyth]

I thank the noble Baroness very much indeed for those comments about the work of local communities, which is clearly key to ensuring that the proper messages go out. We are focusing work, through local communities, on getting messages out about appropriate healthcare, sanitation and so on, but also on trying to alter attitudes to some of the stigma that is associated with orphans and people who have lost close relatives and so on, who will have been in touch with people who have had Ebola. That is a massive challenge too.

I thank the noble Baroness for her comments about Restless Development. I will make sure that the Secretary of State is well aware of her views and the information that she has imparted about the good work that it does. I hope that that can continue. It is important that we work within the local communities on the health messages and messages about burials, as well as ensuring that we have local faith leaders fully onboard to make sure that we get these cases down to zero, which is the Government’s main—indeed, immediate —aim.

[Lord Colwyn (Con)]

Does my noble friend have any news about the development and manufacture of an Ebola vaccine?

[Lord Bourne of Aberystwyth]

My noble friend should be aware that Glaxo-Wellcome has been working on a vaccine in Liberia. There is some progress on the first phase of those trials. As I understand it, it is going into another phase. For the moment that work has been focused in Liberia, but it is now moving into Sierra Leone. There is some progress, but clearly more work needs to be done. The Government have committed £2 million to that project so we are watching that development very closely. Clearly, a vaccine is a breakthrough that we all would welcome massively. There is early progress, but still a long way to go.

House adjourned at 4.02 pm.