Ebola

Lord Chidgey Excerpts

Thursday 8th January 2015 Lords Chamber

[Lord Chidgey (LD)]

My Lords, I, too, add my congratulations to the noble Lord, Lord Fowler, on bringing this debate to us today and on the eloquent way in which he set it out, for which I am very grateful.

There are clearly some fundamental lessons to be learnt from the Ebola catastrophe in west Africa, which can be summarised in terms of healthcare practice and provision, public health resources and general infrastructure. The year-long epidemic has now claimed more than 8,000 lives and infected more than 20,000 people. While the number of new cases in Liberia is falling, it continues to rise in Sierra Leone. The data from Guinea continue to be inconclusive, underlining the remoteness and inaccessibility of the mountainous forest region through Guéckédou, Macenta and Seredou.

Apparently the Ebola virus was discovered as long ago as 1976. I can vouch for the fact that in the mid-1980s, while I was working in the Guinea interior along the borders with Sierra Leone and Liberia, villagers would speak to me of their terror of a killer disease that they believed was caught by eating bush meat from monkeys, which may well have been Ebola. At the time, we were doubling the water supply of the capital city, Conakry, but nothing was being done for the remote villages scattered throughout the interior of the country.

A primary lesson is that by not developing a vaccine to tackle Ebola in the intervening 40-odd years, the pharmaceutical establishment bears witness to the eventual deaths of probably tens of thousands and the infection of many more. The reasoning is unclear, but seems to be associated with concerns over cost recovery from desperately poor communities. However, the cost to the regional economies of decimated and crippled communities does not seem to have been taken into account.

The decision by the board of Gavi, the Vaccine Alliance to support large-scale vaccination efforts with $300 million procurement funding as soon as a safe and effective vaccine is recommended by the World Health Organisation is very welcome. However, the WHO has been strongly criticised for its slow response to the Ebola outbreak, which to date has affected more than 20,000 people and caused more than 8,000 deaths. There are clearly lessons to be learnt on the effectiveness of the mobilisation, distribution and administration of global health relief.

The Ebola outbreak has underlined the need for a fresh approach to strengthening health systems in Africa. Strengthening must be community led. Donors need to prioritise and support community ownership of health systems. The top-down approach does not fully appreciate the spiritual, cultural and political undertones to health that exist among many communities and groups.

The NEPAD organisation of African countries has agreed that each should allocate 15% of GNI to the provision of state-funded universal healthcare, but, so far, there has been little progress. In this context, it seems bizarre that some donors are promoting USA-style healthcare models, based on the principle of private healthcare being purchased by the user, in communities where abject poverty is the norm.

There is now a thing called “Ebolanomics”, or the role of the pharmaceutical sector, which raises many questions about the interaction between market economies and the pharmaceutical sector. That needs to be analysed, understood and reworked into a modern model that responds to the needs of the global population. Barriers that have prevented earlier development of treatment need to be overcome, with more support being focused on the growth of the African pharmaceutical industry. The current business model needs to be redesigned. What would that model look like? Should there be a legally binding framework to guarantee funds to research and to produce and stockpile vaccines for diseases that would otherwise be neglected?

An unforeseen effect of the Ebola epidemic is its impact on programmes to tackle other pandemics, in particular malaria. The Ebola virus is distracting attention from other diseases that still ravage west Africa. Malaria patients in Sierra Leone, Liberia and Guinea—the countries worst effected by Ebola—are now so terrified of the impact of the virus that they will not attend their local hospitals where their malaria could be easily treated with a package of available drugs. Fatoumata Nafo-Traoré, head of the UN’s Roll Back Malaria Partnership, says that without the necessary treatment, malaria patients are going to die.

The economic impact of Ebola on the sub-Saharan region as a whole will be significant, according to Roger Nord, deputy director for Africa at the IMF, who spoke at an Africa All-Party Group meeting recently. He reported that if it takes another nine months to get the outbreak under control, it is expected to reduce growth in Guinea by 1.5% and by around 3.5% in Liberia and Sierra Leone. Neighbouring countries such as Senegal and the Gambia are also starting to see tourism activities decline.

Margaret Chan of the WHO, while recognising the delayed international response and the need for increased international funds, has said that more important than anything else is the need for community funding and support. In this regard, community-level media and radio have an essential role to play, and I pay tribute to the work of the BBC World Service and BBC Media Action, which work with local FM stations that are trusted by their communities. In particular, I pay tribute to BBC reporters in the field who have overcome formidable physical obstacles to reach the most isolated communities in the grip of the Ebola virus.

Much of the work to defeat Ebola is being done by local people. Nigeria and Uganda have sent hundreds of health workers and South Africa has contributed significant funds. The media have a responsibility also to report what African people and Governments are doing to fight Ebola.