Conclusions and Recommendations
1. The initial response of the international
community to the Ebola outbreak in West Africa was totally inadequate.
Although there was evidence that
the Ebola outbreak in West Africa was not pursuing the course
of previous outbreaks as early as April 2014, the World Health
Organisation did not declare the outbreak as a public health emergency
of international concern until early August 2014. At that stage,
over 1,000 cases of Ebola had been confirmed, including over 900
deaths. The outbreak had by then spread from Guinea, where it
had first been recognised in December 2013, to at least 3 other
countries in West Africa (Liberia, Nigeria and Sierra Leone).
The World Health Organisation has rightly been criticised for
failing to act adequately to prevent the spread of the disease
between December 2013 and the end of July 2014. Had the World
Health Organisation acted sooner, it is likely that the outbreak
could have been curtailed sooner. The Department was in a position
as a major donor to many of the international institutions with
a role in containing the outbreak—and the World Health Organisation
in particular—to ensure that the international community
responded more promptly. As we were told by the Department's Chief
Scientific Advisor (Professor Whitty), "… there is no
doubt that multiple bits of the system messed up over this, not
in the first couple of months, when, in a sense, it was very early
in the epidemic, but in that period up to about July".[1]
The Department could and should have listened to and responded
to the views of Médicins Sans Frontières and others
on the ground who were warning of the seriousness of the outbreak
rather than relying on it simply to follow the trajectory of previous
outbreaks, which there was every indication it would not do.
Recommendation: The Department should take
a lead role in the international community's efforts to learn
lessons from this Ebola outbreak. It should also seek assurances
that World Health Organisation staff in all of its regions are
sufficiently capable to identify and respond to future emerging
public health emergencies.
2. The Department was far too slow to react
to the developing situation, missing an opportunity to contain
quickly the outbreak of Ebola in at least Sierra Leone.
The Department confirmed that it had been aware of a confirmed
Ebola outbreak in Sierra Leone in May 2014. In the early stages
of the outbreak, the international community had different views
on how best to react. The Department relied on the view of the
World Health Organisation and paid insufficient attention to the
views of NGOs on the ground that a massive deployment of resources
and healthcare workers was needed to fight the outbreak. There
was also an unfortunate time lag between the Department's recognition
that it had to act and its allocation of funding to deal with
the outbreak. In early August 2014, it had announced £5 million
of support; by September, this had risen to £100 million
and by the time of our hearing, it had reached £230 million.
Had the Department acted sooner, both lives and money would have
been saved. As the Permanent Secretary of the Department (Mr Lowock)
said to us, "I agree with you 100%: had the world, the Government
of Sierra Leone, WHO, we and others acted earlier, it would have
been cheaper and easier to solve the problem."[2]
Recommendation: The Department should make
sure it has procedures and protocols in place which allow a timely
and pre-emptive response to developing public health emergencies
in countries which receive UK Aid.
3. The Department lacked the experience and
capability fully to respond to the outbreak. The
delay in setting up the UK's response to the outbreak was, in
part, due to the absence of organisations that were capable and
willing to deliver the Department's planned interventions, such
as building and operating Ebola treatment facilities. We recognise
that the circumstances of an Ebola outbreak necessitate an incremental
scaling up of operational capacity to create safe environments
for the health workers on the ground. However, the lack of experience
of dealing with medical emergencies—and Ebola in particular—and
the lack of capacity in the Department and its partner Save the
Children, meant that scaling up the operational capacity of the
UK response was slower than it might have been.
Recommendation: A capability gap currently
exists in building and running specialist facilities necessary
to deal with outbreaks such as this. The Department should create
and maintain a detailed contingency plan for sudden onset medical
emergencies to ensure that it can quickly deploy its own and partners'
staff and equipment through a structured intervention process.
4. The lack of health infrastructure in Sierra
Leone inhibited a quicker response to the crisis. The
health infrastructure of Sierra Leone has improved since the end
of the civil war, but remains weak and vulnerable to unexpected
pressures. Corruption remains a major concerns in Nigeria, where
a more developed medical services infrastructure exists in at
least part of the country, local health professionals were able
to respond more quickly to the emergence of Ebola and were therefore
able to contain the disease and prevent its getting out of control.
Looking to the future, the Department correctly agrees with us
that it needs to seek to strengthen Sierra Leone's health system
as a priority through the UK's bilateral aid programme. At the
outset of the outbreak, there were only 120 doctors in the entire
country and only one virologist, who sadly lost his life at an
early stage. The lack of health infrastructure not only hampered
the response to the Ebola outbreak, but has probably led to an
increase in fatalities as a result of other health problems as
the system was overwhelmed.
Recommendation: The Department should prioritise
investment in local health infrastructure of developing countries
in receipt of UK Aid so that there is a better capability to respond
quickly to emerging public health emergencies. It should also
ensure it is doing all it can to support the ability of developing
countries to prevent similar disasters in the future.
5. Political decisions with no basis in scientific
fact hampered the response of the international community, NGOs
and the Department to the growing crisis and led to increased
cost in dealing with the outbreak. Ebola
is a very serious disease and a matter of legitimate fear and
concern to the public. Political reaction to scaremongering on
the part of sectors of the media was predictable, but inevitably
caused difficulties for the international response, in particular
in the revocation of licences to carriers flying direct to the
region. The revocation of licences to carriers to fly direct to
the region was a political decision with no basis in science and
was inconsistent with World Health Organisation advice. As we
were told by one witness (Professor Whitty), "I do not think
that [the decision to cancel direct flights] was a decision driven
purely by science …It was a political decision." The
Department accepts that this decision has caused inconvenience.
In our judgment, it will inevitably have led to an increase in
the costs of dealing with the outbreak and, potentially, to further
loss of life.
Recommendation: There is no scientific justification
for the UK Government's decision to prevent direct flights to
the affected region from the UK, which has likely increased the
cost of dealing with the outbreak. Licences to fly to West Africa
should be restored as soon as possible.
6. There are clear lessons to learn from the
Department's response to the Ebola outbreak. We
recognise that the Department faced a steep learning curve in
implementing its response to the Ebola outbreak. The Department
should capitalise on the knowledge and expertise it has developed
to help prevent, or respond to if necessary, similar outbreaks,
such as Marburg virus disease. The Department outlined a number
of initial lessons from the Ebola outbreak that it intends to
follow up. These included developing early warning surveillance
and improving epidemiological intelligence. By taking the necessary
steps to learn lessons, the Department can help to build confidence
in the UK's response to and expenditure on public health emergencies
overseas. We were told by the Permanent Secretary (Mr Lowcock)
that the Secretary of State has indicated that Parliament should
be involved in this process. We agree.
Recommendation: Once the Ebola outbreak
is brought under control, the Department should undertake and
publish a rigorous evaluation of all aspects of the UK's response
to the crisis. The evaluation should make practical recommendations
as to the steps the Department, other government bodies, the international
community and nongovernmental organisations should take
to prepare for future crises of this type.
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