Ebola Outbreak: DRC

Rory Stewart Excerpts

Monday 20th May 2019 Commons Chamber

[The Secretary of State for International Development (Rory Stewart)]

Ebola is back—this time in the eastern DRC. This is the largest outbreak in the country’s history, the second largest in the world and the first in a conflict zone. So far, 1,209 people have died, and we must do much more to grip the situation. It is not a simple question of virus control. If it were, we could simply repeat what we were able, at huge cost and risk, to do in Sierra Leone and Liberia, and even to some extent what the DRC Government and the World Health Organisation were able to do in Équateur and western DRC over the first six months of last year—that is, to get out into village after village, identify all the cases, trace all their contacts and the contacts of those contacts, and contain the outbreak through preventing further chains of transmission. But this situation is not like that.

This outbreak is in North Kivu, which is the centre of a conflict and is dominated by dozens of separate armed groups, largely outside Government control. Such groups have begun to attack and kill health workers, meaning that key international experts have had to be withdrawn from the epicentre of the virus. The decision not to allow this province to participate in the recent elections—partly on the grounds that it was an Ebola area—has fuelled suspicion that Ebola is a fabrication developed by hostile political forces. As a result, communities are reluctant to come forward when they have symptoms, to change burial practices or to accept the highly effective trial vaccine. The Congolese army and Government, which have successfully contained nine previous Ebola outbreaks over the last 45 years, are struggling to operate in the epicentre of this outbreak, as are the UN peacekeepers and the WHO. Although this area is dangerous and difficult to access, it is not sparsely populated. The epicentre of the outbreak is Butembo, which has a population of 1 million people, and the surrounding areas contain almost 18 million people.

According to all our expert analysis here, the current disease profile poses only a low to negligible risk to the United Kingdom, so this statement should not be a cause for panic here at home. However, this outbreak is potentially devastating for the region. It could spread easily to neighbouring provinces and even to neighbouring countries. I commend all those—both in the Congolese Government and the international community—who are working in very difficult situations to bring this disease under control. My predecessor, the current Defence Secretary, paid tribute to Dr Richard Valery Mouzoko Kiboung, who was killed in an attack by an armed group on 19 April while working on the frontline for the WHO’s Ebola response. I am sure the whole House will join me in expressing our deepest condolences to the family, friends and colleagues of Dr Richard and to all those who have lost loved ones as a result of this outbreak.

We now need to grip this situation and ensure that the disease is contained. As Members can imagine, this has been my key priority in the emergency field since I was appointed to this role just over two weeks ago. I spent the weekend in discussions with UN humanitarian co-ordinator Sir Mark Lowcock and with the Director General of the WHO, Dr Tedros, who has personally paid eight visits to the affected area so far. I have also spoken about the response to the Deputy Secretary-General of the UN, Amina Mohammed. I am pleased to see that there has been a real step-up in terms of the UN staff on the ground regarding co-ordination and the seniority of those staff, particularly in places such as Butembo. Both the Health Secretary and the Foreign Secretary have been supporting this agenda in meetings over the past four days—the G7 health ministry meeting and the WHO meetings in Geneva.

I have convened a meeting with a number of international experts in the field, including Brigadier Kevin Beaton, who helped to lead the UK military response in Sierra Leone and Liberia, and the chief medical adviser to the UK Government. I have concluded, on the basis of their advice, that we need to provide more money immediately, not only to support the frontline response—the health workers—but to support the vaccination strategy and to put more of our expert staff on the ground into the response. This is not just about recruiting doctors. We need people who understand and can work with the DRC Government, the military and even the opposition forces in order to create the space for us to work. We need people who know the UN system well so that they can drive and shape the UN response.

These people need to be not in London but on the ground, because they need to be able to learn and adapt very quickly as the disease spreads. We are already deploying epidemiologists through our public health rapid support teams, in partnership with the Department of Health and Social Care. I am also now considering deploying officials with specialities in information management, adaptive management, anthropology and strategic communications. It is, however, important for us all to understand that this is not a problem that the international community can solve from a distance. This is a political and security crisis as much as a health crisis, and the response must, in the end, be driven by local health workers and leaders.

There are some positive signs. DFID has been a key player in developing a new experimental vaccine for Ebola that is proving highly effective. Over 119,000 doses have been administered in eastern DRC—an achievement that has probably saved thousands of lives. Modelling from Yale suggests that the use of the vaccine has reduced the geographic spread of Ebola by nearly 70%. This is not just about statistics. It is about, for example, Danielle, a 42-day-old baby in eastern Congo who survived Ebola last week thanks to the inspiring work of community volunteers, themselves Ebola survivors, and frontline health workers, supported by UK Aid.

Of course, we cannot do this alone. It needs grip and urgency, but it also needs humility. One of the reasons I have been talking in detail about this issue to Mark Green, my US opposite number, is not only that we share the US’s analysis but that the Americans will inevitably be major players in this response in terms of finance and expertise, as indeed they were in the Liberia Ebola outbreak. We need many more international donors to match our financial contributions and to sustain the international and local health operations in the field. That is why the UK has just hosted an event specifically on Ebola to build support for the response in the World Health Assembly in Geneva. It is also why I have agreed that my colleague, the Africa Minister, should visit eastern DRC immediately.

This is a very dangerous situation where the Ebola virus is only one ingredient in a crisis that is fuelled by politics, community suspicion and armed violence. We need to act fast and we need to act generously. But above all, we need the right people on the ground who are completely on top of the situation and able to come up with quick solutions and to guide us in keeping up the support for—and, yes, sometimes the pressure on—the UN system, on non-governmental organisation, on opposition politicians and on the Government of the DRC to get this done. The stakes are very high. I will keep the House updated on our response.

[Dan Carden (Liverpool, Walton) (Lab)]

I thank the Secretary of State for advance sight of his statement and for its comprehensive nature. I would like to start by joining him in commending all those who are working to fight this outbreak, honouring Dr Richard Kiboung, who was killed last month, and expressing our deepest sympathies to all those who have lost their lives to the latest Ebola outbreak in the DRC.

The death toll currently exceeds 1,000 people, and as the number of confirmed cases continues to rise, this deadly and cruel virus is certain to claim more lives in the days and weeks to come. The World Health Organisation has said it is unlikely that the virus will be contained, so its spread into neighbouring countries is not only possible but likely. This assessment from the WHO means that the world must act fast to prevent catastrophic outcomes, given the speed with which Ebola can contaminate and kill. David Miliband, who recently visited the region, confirmed that

“the Ebola outbreak is getting worse, not better, despite a proven vaccine and treatment.”

Through the Department for International Development, the UK is already playing its role in the response and making a difference on the ground, as it has done in previous outbreaks. Real credit is due to DFID’s staff and all responders for their tireless work and commitment. I am pleased to hear that the Secretary of State is discussing further action that DFID can take with other donor countries. Every day is crucial, and getting the response right is imperative. It is not simply a matter of issuing more money or resources. Given the complex security context laid out by the Secretary of State, a more hands-on and strategic approach is urgently needed.

It has been widely reported that one of the major barriers to delivering the necessary response is the breakdown of trust between the affected community and those trying to lead the response. A quarter of people in the region believe that the Ebola virus does not exist, and a third think that it was fabricated for financial gain. Foreigners have been accused of bringing Ebola to the DRC, and armed groups have stormed health centres and killed staff members.

Medical humanitarian agencies, such as Médecins sans Frontières, that have the expertise and experience to fight Ebola are being forced to suspend activities in the face of threats of further violent attacks. As a result, people are left untreated, vaccines are not administered, and the majority of Ebola-related deaths are now occurring within the community rather than health clinics. Lack of infection control and safe burials only speeds up the spread of the virus. In April, the country recorded its highest number of cases since the outbreak began, and we can expect this month’s caseload to be higher. Transmission is occurring in highly populated areas where health systems are weak and hundreds of armed groups operate.

What specific steps is the Secretary of State taking to ensure that all agencies prioritise working with the Congolese community in their response? What urgent steps is he taking to gain the trust of the Congolese community? Can he tell us more about his discussions on supporting efforts to stop the current rumour mill of misinformation and secure negotiated access to the affected population?

What more can the Secretary of State do to reduce the problematic dependence on armed escorts and military involvement in the implementation of humanitarian activities? Agencies active on the ground report a major difficulty being that actors involved in the Ebola response are the very same actors who have played a long-standing role in the ongoing conflict in the region. Can he give an assurance that he will uphold the principles laid out in the Inter-Agency Standing Committee guidelines, which state that military and civil defence assets should only ever be employed by humanitarian agencies as a last resort? Crucially, while we want to see everything done to get this emergency situation under control, does he agree that prevention is better than emergency response and that we must provide long-term support to ensure that the DRC can build appropriate public health systems for the future?

[Rory Stewart]

I thank the hon. Gentleman for his moving and well-informed response to the statement; it is clearly very well informed by some of the actors on the ground. I will reply specifically to two of his questions.

On stepping up co-ordination, an assistant secretary-general of the UN is now operating out of Butembo with a broader co-ordination role for the different UN agencies. We have reached out to opposition leaders, who yesterday made the first in a series of statements to communities to encourage them to come forward to report cases. This is really important because those opposition leaders were at least complicit passively in allowing the rumours to spread that Ebola was somehow an invention of the Government, so there has been a very important shift. We want to thank those opposition leaders for coming forward and making those statements, and we would encourage them to make more such statements. Clearly, the Ebola response should not be politicised and should not be caught up in people’s disagreements with this particular Government in Kinshasa.

On the military-security relationship, the hon. Gentleman is absolutely right that we should be using military personnel only as a last resort, but it is very difficult situation. Nearly 200 separate insurgencies are taking place in the DRC—in particular, the Allied Democratic Forces and the Mai-Mai groups, which are operating in North Kivu and the surrounding areas—which, as we have said, have killed a doctor, mounted at least two attacks on Médecins sans Frontières facilities and attacked up to 40 other health facilities. With these kinds of problems, and when we are protecting our health workers not just from the risk of getting Ebola itself—health workers are of course among the individuals most at risk of contracting Ebola—but literally protecting them from being shot or attacked, it is understandable that in certain cases we have to work either with UN troops or the army of the DRC to address this outbreak.

We need to be very realistic about what this whole situation means. Part of that is resilience and, absolutely, investment in the public health facilities in the DRC. However, we should remember that the DRC Government have dealt with nine previous outbreaks. In fact, Ebola is named after a river in the DRC, and it was first discovered because of an outbreak in the DRC. The Congolese army and the DRC Government actually have a huge amount of experience in dealing with this. Their failure to grip it here is specifically about the conflict in North Kivu, rather than necessarily about their having the skills and experience to deal with it.

Finally, we need to invest in resilience in the neighbouring countries to make sure that were the disease—God forbid— to move into Uganda, Burundi or Rwanda, we have the proper response in place to contain it in each of them.

[Mrs Pauline Latham (Mid Derbyshire) (Con)]

Last time I was in Uganda, I was shown the preparations that were being made in case Ebola did come across the border, but I did not feel they were adequate enough. There was one bed, as part of a health facility, which just had a curtain around it. Will my right hon. Friend explain what we are doing to help, because this will not respect the border of a country and it will cross? Will the Secretary of State explain exactly what we are doing to help the countries bordering the DRC to stop it spreading into their country?

[Rory Stewart]

The answer is that we have much more experience now than we did 10 years ago of dealing with this, particularly because of the experience in Sierra Leone and Liberia. That means partly that we are giving money to agencies such as Oxfam so that it can provide its own experts in the field and support to the WHO both in resilience preparedness and in work with the public health authorities in those countries. We know what we are doing; we have the skills; and we know how to run a good technical Ebola clinic. I am very concerned to hear this news from Uganda and I am very happy to look at the individual case, but we certainly can do much better than that and we generally are doing much better than that.

[Douglas Chapman (Dunfermline and West Fife) (SNP)]

May I thank the Secretary of State for pre-sight of his oral statement? Thanks are due in no small measure to those who are already working on the ground. That point was made by the Opposition Front Bencher, the hon. Member for Liverpool, Walton (Dan Carden), and indeed by the Secretary of State.

With 1,600 cases and almost 1,200 deaths, the outbreak in the DRC is the second largest in history. It has a 67% fatality rate 10 months after it began, and the case numbers are still rising and escalating as we speak. As we know, the disease disproportionately affects women, in 55% of cases, and children, in 28% of cases. The International Federation of Red Cross and Red Crescent Societies has warned that it may have to scale back operations dramatically in the DRC because of underfunding and some of the security issues that the Secretary of State mentioned in his statement.

I have two questions for the Secretary of State. First, on vaccines, he might remember that my hon. Friend the Member for Central Ayrshire (Dr Whitford) noted in a recent article for The BMJ that

“modern air travel means it is not possible to ignore infectious diseases that occur ‘far away’ as of no concern here”.

Does he agree that vaccines are a key weapon in the fight against this disease, at home and abroad, and if so, what steps is his Department taking to combat the disinformation about vaccines worldwide? I think that problem is bigger than what we are dealing with today.

Secondly, during the west Africa epidemic of 2014 to 2016, funerals were a major source of Ebola transmission, causing almost 80% of infections in Sierra Leone. What steps is the Department taking to ensure that safe and speedy burials are provided across the worst affected areas?

[Rory Stewart]

There are three issues. First, I absolutely agree that we need to work very closely with everyone, including all Members of this House, to combat the very dangerous lies about vaccines. Vaccines are absolutely vital. They have transformed life expectancy around the world. We cannot allow conspiracy theories about vaccines to lead to unnecessary deaths.

Secondly, in eastern DRC, there are two types of vaccines available: one developed by Merck, and one developed by Johnson & Johnson. The trials of the Merck vaccine were very successful in Guinea. We are beginning to roll out the Johnson & Johnson vaccine. There is an issue with how long it takes to make these vaccines; because they still have to be biologically incubated through an egg, it can take between six and 12 months to create the vaccines. Pushing towards 350,000 over the next six months will therefore require enormous drive and effort.

Finally, on burial practices, we must ensure that we are anthropologically sensitive. Family members want to be able to see their loved ones before they bury them, so we have to bring them in wearing hazmat suits and ensure that they see the chlorine spraying of the body. In certain cases, in addition to wrapping the body, we need a clear site so that they can see the face, so that some of the rumours that have been going around about organ harvesting can be dealt with directly. In eastern DRC, this is about reassuring not only the family, but the broader community.

[John Howell (Henley) (Con)]

One of the big problems is that that part of the world is characterised by a large number of refugees, due to the inherent instability of the region. How will my right hon. Friend tackle Ebola among refugees to ensure that it does not spread to other countries?

[Rory Stewart]

My hon. Friend is absolutely right. The ongoing conflict in eastern DRC, which has been going on for decades, involves Congolese citizens moving in large numbers into neighbouring countries, and some of the insurgent groups, such as the Allied Democratic Forces, are citizens of other countries—a lot of people originally born in Uganda and Rwanda are now fighting in eastern DRC. That means we need to deal with the situation in two ways. We need to think about those people returning to their host countries, but we also need to think about vaccinating within the camps for refugees and internally displaced people. Our aim will be to try to do a complete vaccination of those camps and communities.

[Kevin Brennan (Cardiff West) (Lab)]

My constituent Ben Thomas came to talk to me about this on Saturday. The combination of this terrible disease, in an area with 18 million people dominated by separate groups, as the Secretary of State described, out of Government control, with the conspiracy theories, reads like the nightmarish script of some disaster movie. How sure is he that the risk of this spreading and eventually coming to the UK is negligible, and what is he doing with other Departments to ensure that we are ready for such a possibility?

[Rory Stewart]

That, of course, is the central question. Our colleagues in public health conduct an analysis on a real-time basis and publish every two weeks their view of the risk to the United Kingdom. They publish the risk of vectors of transmission that they are aware of. They look at the fact that eastern DRC is a relatively remote area, with no direct flights to the United Kingdom, and there is a very limited number of people from the diaspora community of eastern DRC in Britain. However, if Ebola continues to spread, that fortnightly update will change. The current negligible risk could move up, which is why we need to watch this very closely. If it were to move to Uganda, two factors would come into play. Uganda has a better public health system, so it should be able to trace contact to contact and contain Ebola more rapidly, but there is the risk of the direct flights to the United Kingdom, so we need to keep the House updated very closely on that. At the moment, I think their assessment is correct. However, should the situation change, our assessment will need to change.

[Jeremy Lefroy (Stafford) (Con)]

I thank my right hon. Friend the Secretary of State and the Opposition spokesman, the hon. Member for Liverpool, Walton (Dan Carden), for their very measured and detailed statements and replies. May I ask the Secretary of State about the situation in Goma? As far as we know, there are no cases in Goma at the moment, but it is a very large population centre. It seems, from the information I have, that it is not well prepared. Should the disease reach Goma, that could have extremely dangerous consequences. Goma is home to large numbers of refugees, as my hon. Friend the Member for Henley (John Howell) pointed out.

[Rory Stewart]

In terms of the worst-case scenarios we are looking at, Goma is a very serious situation. Butembo, as I explained to the House, has a population of 1 million. Goma is far larger. It is a considerable urban settlement and a major trading port right across to Rwanda. It would not be possible to vaccinate everybody in Goma. There are simply more millions of people than we have vaccines to insert. It is therefore very, very important that we contain the outbreak by ring-vaccination around the area of Butembo. If it moves to Goma, we will have to move to a totally different stage of response, so we must do all we can to prevent that happening.

[Nick Smith (Blaenau Gwent) (Lab)]

I thank the Secretary of State for his statement, which was very helpful. I understand that in Sierra Leone’s most recent Ebola outbreak nearly 10% of that country’s health professionals were killed. This disease can therefore have a huge impact on a country. The Secretary of State talked about much distrust surrounding this outbreak. Will he say more about what is being done to raise awareness and emphasise the impact of Ebola, so we can contain it?

--- Later in debate ---

[Rory Stewart]

There are two main lessons from Sierra Leone. The first is communication—in particular, making sure that anybody who is sick comes forward to report it and that they report their contacts honestly. We had a situation recently in eastern DRC where a baby was reported, but nobody traced the fact that the grandmother of the baby had actually had the disease. Contact tracing and reporting is essential. The second relates to safe burial practices and understanding very clearly the risks involved.

In terms of health workers, the big change from Sierra Leone is the vaccine. One of the great achievements that this Department has played a major role in is the final development of an Ebola vaccine, which, so far, has been very effective—over 90% effective. We are now vaccinating all health workers in the area as a matter of course, so that anyone who is in contact with a patient is vaccinated. That should make a huge difference to the transmission of the disease, because in Sierra Leone and Liberia it moved through health workers. The problem at the moment is traditional health workers, who are reluctant to come forward.

[Alex Chalk (Cheltenham) (Con)]

For intervention to be decisive, clinical experts will have to be deployed at pace and at scale. Will the Secretary of State indicate what discussions he is having with our international counterparts to ensure that such resources, as are required from us and our allies, are deployed as quickly as possible?

[Rory Stewart]

From discussions in the Department, we have agreed a scale-up of the UK response. We have laid out the additional UK experts who want to go into the field. I have spoken to Mark Green, the administrator of the United States Agency for International Development. A retired US admiral who led their response in Liberia has just been out in the field in eastern DRC and has returned to Washington. I hope that a colleague will be able to meet him in Washington this coming week. The third thing is making sure, with Dr Tedros and Mark Lowcock from the WHO and the United Nations Office for the Co-ordination of Humanitarian Affairs, that we get the right UN experts in the field. My hon. Friend is absolutely right: more expertise, more quickly and closer the epicentre is the key.

[Tom Brake (Carshalton and Wallington) (LD)]

I welcome the Secretary of State to his new role. He is perhaps that rare animal—a Minister who is respected on both sides of the House—so I wish him well. He will know that in 2014, the Ebola outbreak was classified as a public health emergency of international concern, as was the Zika outbreak in 2016. I assume that he is monitoring that. At what point does he think we might reach that stage, and what additional resources would that bring to tackle the outbreak?

[Rory Stewart]

That is a very good, technical question. Let me take the two responses in reverse order. First, we do not believe that the declaration would make a dramatic difference to the resources that we are able to deploy. In fact, we have just signed off on very significant additional resources. For various security reasons, I feel that we cannot talk about the exact sum, but we are putting much more resource into this operation. Secondly, we are monitoring this issue and the entire meeting last week was around that. It is an active question for the discussion currently taking place at the World Health Assembly, and we will keep the House updated on the declaration of the emergency.

[Jamie Stone (Caithness, Sutherland and Easter Ross) (LD)]

I congratulate the Secretary of State on taking up his role; the introduction of a Scot always helps matters in sensible decision making. My question is simple: in terms of mobilising all our forces and getting the vaccine on tap as quickly as possible, are we making the maximum use of one of our strengths, which is British academia? One thinks of Oxford, Cambridge, Glasgow, Edinburgh and Manchester, where we have some tremendous medical specialists.

[Rory Stewart]

The answer is yes. British academics are playing a very major role, but a lot of the Merck development has included not just British but American and Canadian academics. The point is well made. We are very proud in DFID that the quest for a universal snakebite vaccine, for example, will be led through the Liverpool School of Tropical Medicine and funded entirely with DFID money. That is an example of where I, as a Scot, would very much like to take this Department.