1 The UK's response to the outbreak
of Ebola Virus Disease in West Africa
1. We took evidence from the Department for International
Development (the Department) and from two of the Department's
delivery partners, Save the Children and the International Rescue
Committee, on the UK's response to the Ebola outbreak in West
Africa.
2. The current Ebola outbreak in West Africa is the
largest known outbreak to date, with over 17,000 cases and 6,000
deaths reported up to 30 November 2014.[3]
The UK government has committed a £230 million package of
direct support to help contain, control and treat the Ebola outbreak
in West Africa. As of 10 December 2014, £125 million had
been spent.[4] The UK response
is focused predominantly on Sierra Leone[5]
and is coordinated by the Department, but also involves the Ministry
of Defence, the Foreign and Commonwealth Office and the National
Health Service.[6]
3. We asked the Department how Nigeria had managed
to control the Ebola outbreak when Guinea, Liberia and Sierra
Leone had not managed to do so. The Department attributed this
to the fact that the Nigerian authorities had got on top of the
first two or three cases very quickly and had followed up all
the subsequent ones. This demonstrated that if cases of Ebola
were identified early and isolated quickly, an epidemic could
be controlled in a relatively short period of time. In part Nigeria
was able to respond more quickly because it had a stronger health
infrastructure. The health infrastructure in Sierra Leone was
very weak, with only one virologist. Witnesses recognised that
the UK should have done more in the past to support the building
of a resilient health system.[7]
By contrast with Nigeria, in Guinea, Liberia and Sierra Leone,
the epidemic gathered momentum and spiralled out of control.[8]
4. The Department noted that the real failure of
the international community was that between December and March
it had known that there was an Ebola outbreak in Sierra Leone,
but the expectation had been that it could be brought under control,
as all previous outbreaks had been. Then there had been a delay
between March and the end of July when the international community
did not move fast enough, which was the point at which the Ebola
outbreak was allowed to take off. The Department considered that
had the kind of things that were done in Nigeria been done in
Sierra Leone, the outbreak could have been headed off at a much
earlier stage.[9] A range
of commentators led by Médicins Sans Frontières,
a recognised authority on Ebola, have criticised the international
community's response to the outbreak.[10]
5. The Department noted that the first indication
in Sierra Leone that it needed to prepare for an outbreak had
been in February and that the first confirmed case of Ebola had
come some time later. The Department explained that the epidemic
started in Guinea, spread to Liberia, and a little while later
to Sierra Leone. The expectation at that time among most people,
but not Médicins Sans Frontières, which "was
much better at identifying what was about to unfold"[11],
had been that the outbreak would essentially be quite like all
the other known outbreaks: localised and relatively quickly brought
under control. The Department told us that it had highlighted
to the World Health Organisation and other multilateral organisations
in April 2014 that the epidemic in Sierra Leone appeared to be
behaving differently from past outbreaks and that the planning
assumptions could be wrong.[12]
The Department noted that it was the World Health Organisation's
prerogative to declare a 'Public Health Emergency of International
Concern'—an event which constitutes a public health risk
to other states and to which a coordinated international response
is required.[13]
6. While the Department was aware of an Ebola outbreak
in Sierra Leone in May 2014 it did not allocate the first tranche
of additional funding to the crisis—£5 million—until
early August 2014.[14]
In September 2014, it allocated a further £100 million. By
the time of our evidence session the Department had announced
funding of £230 million and the Department told us that the
total funding could rise to some £330 million.[15]
7. In the early stages of the Ebola outbreak, epidemiologists
and the international community held different views on how best
to react.[16] In June
2014, Médicins Sans Frontières, working on the ground,
warned that a massive deployment was necessary to control the
outbreak.[17] The Department
explained that in deciding how to respond to the outbreak it had
relied on the views of the World Health Organisation, which it
believed represented the consensus at that time. The Department
also told us that it would consider what measures it needed to
put in place so that it could respond with greater confidence
to future public health emergencies without relying solely on
the views of the World Health Organisation.[18]
8. The UK Ebola response package includes the construction
of treatment facilities, the provision of treatment and isolation
beds, and the training and management of burial teams. The package
was established in the second half of August when the World Health
Organisation declared the Ebola outbreak a public health emergency
of international concern. However, the Department did not agree
a partner, Save the Children, to construct and run its facilities
until 8 September 2014. The Department told us that this delay
in setting up the UK's response had been due predominantly to
the absence of organisations that had both the capabilities and
willingness to deliver the Department's interventions. The Department
confirmed that it did not have a staff or resource register akin
to that of the Stabilisation Unit in place for medical emergencies.[19]
9. The first UK-constructed treatment centre in Sierra
Leone, which is managed by Save the Children, opened in November
2014 in Kerry Town.[20]
The Department has been criticised in the media over the speed
with which the Kerry Town facility has opened beds.[21]
The Department told us that it had always planned to scale up
the operating capacity of the facility incrementally in line with
Médicins Sans Frontières' protocols for a
safe and effective operating environment. It assured us that the
UK facilities were on track to meet their planned capacity targets,
including the scale-up in Kerry Town where 80 beds were due to
be operational by the end of December. The Department recognised
that it should have communicated to the public in the UK and in
Sierra Leone more clearly that the build up of facilities would
be gradual.[22]
10. Save the Children told us that everyone involved
in Ebola, apart from Médicins Sans Frontières, the
world renowned experts in this field, had had to work out of their
comfort zone and noted that it had been "an incredible group
effort, not just between staff of the NHS, MOD and Department
of Health, to get to a point where we have over 450 individuals
working in the [Kerry Town] facility at the moment". The
Department recognised that it could learn lessons from its response
to the Ebola outbreak once it has been contained which might be
applied to an outbreak of, for example, Marburg viral disease.
It highlighted three issues on which it would focus its attention:
developing early warning surveillance and improving epidemiology-led
intelligence; developing a larger set of response institutions
that can be deployed more quickly; and, making sure that technologies
relating to vaccines, testing and treatments were being afforded
sufficient priority by the international community.[23]
11. The Department noted that the health systems
in Sierra Leone were starting from an extraordinarily low base
following the end of its civil war which had destroyed virtually
every institution in the country. Despite the massive challenge
of rebuilding the health sector, UK efforts to do so over the
past 15 years had resulted in progress before Ebola on some key
health outcomes, such as child mortality, but the system had been
overwhelmed and swamped by the Ebola outbreak. The Department
recognised that it would need to pay more attention to strengthening
Sierra Leone's health systems through its bilateral aid programme.[24]
3 World Health Organisation Situation Report 3 December
2014 Back
4
Q 35 Back
5
Q 8, Ebola virus: UK government response - Response in Africa Back
6
Qq 54, 61 Back
7
Q 19 Back
8
Q 6 Back
9
Q 6 Back
10
Q 40; Médicins Sans Frontières, Ebola: the
failure of the international outbreak response, 29 August 2014;
International Development Committee report Responses to the
Ebola Crisis, Eighth Report of Session 2013-14, HC 976, 15th
December 2014, paragraph 3 Back
11
Q 9 Back
12
Qq 9, 10 Back
13
World Health Organisation Statement on the 1st meeting of the
IHR Emergency Committee on the 2014 Ebola outbreak in West Africa,
8 August 2014 Back
14
Britain to extend assistance to combat Ebola in West Africa, Department
for International Development, 7 August 2014 Back
15
Qq 9, 35 Back
16
Q 11 Back
17
Médicins Sans Frontières Ebola in West Africa:
The epidemic is out of control, 25 June 2014 Back
18
Q 14 Back
19
Qq 33, 34, 41, 42 Back
20
Q 41 Back
21
Sierra Leone Foreign Relief Operation Criticised, BBC, 30th
November 2014 Back
22
Qq 38, 51 Back
23
Qq 40, 57, 59 Back
24
Q 18-19, International Development Committee report Responses
to the Ebola Crisis, Eighth Report of Session 2013-14, HC
876, 15th December 2014, paragraph 14 Back
|
