Ebola: Sierra Leone

John Bercow Excerpts

Tuesday 19th January 2016 Commons Chamber

[Stephen Phillips]

I am grateful to my right hon. Friend for that answer and, indeed, for coming to the House urgently today to answer questions on this subject. I am also grateful to her for the leadership she demonstrated during the Ebola outbreak of 2014-15, as I am to the brave military and civilian personnel who travelled to Sierra Leone to help west Africa during that period.

On 7 November 2015, the World Health Organisation declared Sierra Leone free of Ebola following a period of 42 days during which no new cases had been reported. Just last week, as my right hon. Friend has said, the WHO made a further declaration to the effect that, all reported transmissions having ended, the outbreak of Ebola in west Africa was over.

My right hon. Friend and the whole House will therefore have been dismayed at yesterday’s reports of the death from Ebola of a young woman in the northern Tonkolili district last week, particularly given that she appears to have travelled in three other provinces during the infectious stages of the disease.

What steps is my right hon. Friend taking, together with her colleagues in the Foreign and Commonwealth Office and the staff of our high commission in Freetown, to determine the source of this latest outbreak? Is she confident that the outbreak can be contained, given that the burial customs observed do not appear to have followed the procedures necessary to prevent further contamination? Are the quarantine measures adopted by the Government of Sierra Leone sufficient to ensure that widespread transmission of the virus is unlikely?

The assistance provided by the UK during the last outbreak cost the British taxpayer £427 million. My right hon. Friend will remember that I first asked about that outbreak in the House on 18 June 2014, at a stage when the number of cases was in the tens, rather than the thousands. None of us wishes to see a further significant outbreak, but is she working with her officials, the Government of Sierra Leone and the WHO to ensure that we get on top of the problem at a stage when relatively few individuals are likely to have been exposed?

It is fair to say that the worst epidemiological predictions during the previous outbreak did not materialise, but across west Africa more than 11,300 people died of Ebola in 2014-15. Many more died of preventable disease, which an overburdened and fragile health care system was incapable of addressing at the same time as dealing with Ebola.

What funding will my right hon. Friend make available to the Government of Sierra Leone and non-governmental organisations working in the region to deal with this latest outbreak and to establish long-term resilience in healthcare systems for dealing with a disease that may well now be endemic in the region? Has she held discussions with her colleagues in the Ministry of Defence about the potential for assistance to be given to ensure that the disease does not spread further? Does she have confidence that the failings demonstrated by the WHO in the past will not be repeated? To what extent is she confident that there are no further cases of Ebola present in Liberia and Guinea?

Retesting of samples taken from individuals who died in the 10 years prior to the 2014-15 outbreak indicated that Ebola may well have been present in west Africa for more than a decade. To the extent that Ebola is now endemic, what measures will my right hon. Friend and the Government support leading to the development of an effective vaccine for the virus? When does she expect that vaccine to be available?

The previous outbreak of Ebola and its spread across an interconnected world indicated the threat faced by the United Kingdom from the spread of hitherto unheard- of diseases. Direct flights have recently recommenced from Sierra Leone to London, but my right hon. Friend will know that the previous ban on such flights was unnecessary and, indeed, counterproductive. Will she assure the House and the Sierra Leonean diaspora in this country that the mistake of banning direct flights in the past will not be repeated?

Finally, the long-term prognosis for those previously infected with Ebola is not well understood by the medical profession. From cases such as that of Pauline Cafferkey, we now know that the virus can hide in the body for lengthy periods. Is the NHS aware of the risks of Ebola re-emerging in patients who have previously survived the disease? What assistance are the Government giving to non-governmental organisations and Governments in west Africa to ensure the long-term health of those who have survived Ebola and may still be able to pass it on to others? Specifically, what, if any, monitoring project does her Department intend to fund so that the disease is stamped out both for individuals in the region and to secure the biosecurity of the United Kingdom and those of us who live here?

[Mr Speaker]

Order. Before the Secretary of State responds, let me say to the hon. and learned Gentleman that his erudition, which is never in doubt, has been equalled today only by his length. He is a very sophisticated denizen of the House, and he has treated of a very serious matter. I am aware, and the House will also be conscious, that on top of that he is an illustrious Queen’s counsel. Perhaps I can express the hope that he does not charge his clients by the word, for if he does he will be a great deal richer and they, I fear, will be a great deal poorer. From now on, we must try to stick to the time limits allocated for this purpose. I say that in a good spirit, because he has raised a very important issue and done so in an extremely intelligent way. If we operated within the time limits from now on, the House would greatly appreciate it.

[Justine Greening]

I must say, however, that my hon. and learned Friend achieved amazing value for money in the number of questions asked during the time spoken, for which I commend him.

To respond to the very serious issues that my hon. and learned Friend raises, from the very beginning this has been an unprecedented outbreak. We are seeing that even now, given the length of time that the virus appears to stay in the bodies of survivors after they have fully recovered. That is one reason—as we are still learning, frankly, about the implications of the virus’s persistence in survivors—why part of the work we are doing in Sierra Leone is to mitigate the risks of its being passed on. We are doing so through verifying survivor registers so that we know who should be on the list to be tested; offering safe sex counselling; establishing semen testing; ensuring access to free healthcare; and combating survivor stigma. It is critical to working with the people who may be most at risk of passing on a disease that they have themselves have survived. There is now a national semen-testing programme for male survivors aged 15 and above. Indeed, DFID and Public Health England are working with the Government in Sierra Leone to make sure that it works effectively.

We saw the same in Liberia, a country that also passed its 42-day Ebola-free point, but subsequently had other cases. That is precisely why we have been so vigilant. Indeed, it was the processes, systems and testing that we put in place with the Government in Sierra Leone that have picked up this particular case and enabled us to go through the processes of contact tracing and quarantine. As my hon. and learned Friend pointed out, it is known that this student had travelled extensively, which makes our task all the harder. We are therefore working at district level. One thing we have set up is a mobile field hospital that can rapidly get to a particular district if an outbreak takes place. He asked about the quarantine measures. They are indeed being put in place, and the contact tracing is happening.

My hon. and learned Friend asked about funding in relation to the latest outbreak and about how we are working more broadly to help get to what I call “resilient zero”. Having got past the maximum period of the main outbreak, which was incredibly difficult, we all expected that sporadic cases would continue to appear. We are now in that phase. As he says, getting on top of such cases is the way we will reach “resilient zero”, when we can be more confident that there will not be any future cases. There is funding for the latest outbreak, to cover some of the things I have mentioned and for work in schools to make sure that issues of water and sanitation are understood and that the basic steps that can be taken at community level are put in place to minimise the risk of passing on diseases, including Ebola. The district-level response mechanism that we used so successfully to get over the major outbreak when it was at its peak is still there. The London School of Hygiene and Tropical Medicine estimated that we saved more than 56,000 lives through the work that we put in place with the Government of Sierra Leone to get on top of the outbreak.

My hon. and learned Friend asked about the vaccination process. Prior to the crisis, DFID was involved in the development of early stage vaccines, which can now tackle Ebola. He will know that there are some promising candidates, which give us the prospect of being able more readily to clamp down on future outbreaks.

My hon. and learned Friend spoke about health system strengthening. One of the key messages that came out of the Ebola outbreak was that countries such as Sierra Leone and Liberia that, in the scheme of their histories, were newly emergent from civil war, were less able to cope, simply because their health systems were at an earlier stage of development due to those conflicts. Other countries in the region, such as Nigeria, were better able to clamp down on the outbreak simply because they had stronger health systems, although there is some way for even that country to go.

To reassure the House, it is not a surprise to see these sporadic additional cases, but the people, processes and systems are in place on the ground in Sierra Leone to identify them and respond rapidly.

The final thing that my hon. and learned Friend mentioned was flights. We felt that the decision that we took on direct flights was in the interests of our national security. I think that it was the right decision to take.

Critically, the way in which we got on top of the outbreak in the end was by working with our fantastic Foreign Office as one team to bring the best of British—our military, our doctors and nurses, Public Health England—and working hand in hand in partnership with the Government of Sierra Leone to provide a platform that the rest of the international community could work on to combat the disease. I again put on the record my huge thanks not only to the many DFID staff I am privileged to lead, but to all the other people across Government and all the public sector workers who in many cases put their lives on the line to help Sierra Leone get to grips with this terrible crisis.