1Introduction
Background
1.Beginning in late 2013 an epidemic of Ebola virus disease in West Africa, concentrated in Guinea, Sierra Leone and Liberia, infected 28,637 people and caused 11,315 deaths.1 This was the deadliest outbreak of Ebola in history and the first time that such an outbreak had reached epidemic levels. While nearly all of the reported cases occurred in the three epicentre countries, this was also the most geographically widespread Ebola outbreak in history with a small number of cases reported in seven other countries (Italy, Mali, Nigeria, Senegal, Spain, the United Kingdom, and the United States of America).
Box 1: Dr Jeremy Farrar, Director, Wellcome Trust speaks about epidemics
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“The key priority is to appreciate that these will happen with increasing frequency in the new world. Climate change, migration, movement of people, urbanisation, different relationships between humans and animals and the agricultural sector will inevitably mean we have more epidemics. The capacity to spread these around the world at a rate that we have not had before means we will be challenged by them wherever you live in the world, and we have seen that over the last 12 years.” |
Source: Q19
2.The first case occurred in December 2013 in Guinea, followed by a formal diagnosis and declaration of an outbreak in March 2014. The disease spread to Liberia in late March 2014 but by May the number of new cases being reported each week had dwindled, leading to “a sense that the outbreak had in fact subsided.”2 In late May 2014 the first cases were officially reported in Sierra Leone and the number of cases across the region began to surge again. By the middle of June the outbreak had killed 337 people, making it the deadliest in history. On 7 August the World Health Organization formally declared the epidemic a Public Health Emergency of International Concern (PHEIC).
3.The Department for International Development (DFID) committed funding to the frontline response in July 2014, prior to the declaration of a PHEIC, before becoming directly involved in August and rapidly increasing efforts in September. This included the deployment of British military personnel and the building of six Ebola Treatment Centres in response to a UN request that it “take on leadership of the international effort to contain Ebola in Sierra Leone.”3 The epidemic peaked in late November 2014 and then steadily declined. Liberia was declared Ebola-free on 9 May 2015, defined by the World Health Organization as 42 days after the last reported case completes treatment, but a small number of new cases were again reported in late June and July. It was again declared Ebola-free on 3 September, but again a small number of new cases emerged in late November. Sierra Leone was declared free of Ebola on 7 November by the World Health Organization; Guinea was declared free of Ebola on 29 December; and Liberia will be declared free of Ebola for a third time on 14 January if no new cases arise, which will mark the end of the outbreak.
4.We reiterate the previous International Development Committee’s commendation of all those who worked to tackle Ebola. We praise those who risked their lives to bring the epidemic under control, including the Sierra Leonean people and UK personnel who volunteered. We also pay tribute to all of those who lost their lives in the fight against Ebola.
Our inquiry
5.Our predecessor Committee visited Sierra Leone in June 2014, before the full scale of the epidemic was clear, as part of its inquiry into Recovery and Development in Sierra Leone and Liberia.4 As a result, and building on its related report on Strengthening Health Systems in Developing Countries,5 it carried out a short inquiry into Responses to the Ebola Crisis.6 Its report was published in December 2014, commenting on the then-current efforts to bring the epidemic under control. We decided that we should follow-up on that report in order to take stock and determine what lessons had been learned from the outbreak and the response to it. The Science and Technology Committee has also recently inquired into lessons drawn from the Ebola outbreak, in particular “concerning the use of scientific advice in the UK for similar disease outbreak emergencies in future.”7 Our report therefore focuses primarily on DFID’s role and the international response to the outbreak. We look forward to the publication of their report.
6.We launched our inquiry on 13 July 2015 and asked for written submissions on what lessons had been learnt from the events in Guinea, Liberia and Sierra Leone, specifically with regards to the following terms of reference:
- Timeline of response–what could have been done better and quicker? How can this be prevented from happening again? Does DFID have the capacity to deal with future outbreaks? Is there enough expertise in DFID?
- How did Ebola get to the stage it did, what failed in the three months preceding DFID involvement? What can be done in future to assess and diagnose diseases more rapidly?
- What impact did cultural practices have on the spread of Ebola?
- What can be done to address such issues in the future?
- What was the decision-making structure between DFID and the MOD? Who was ultimately responsible? Was using the military more efficient than using NGOs? How successful were the setup of the hospitals, how many patients were treated?
- Was all the funding spent? How was it spent? How was it monitored?
- How will Sierra Leone recover and rebuild itself? Is there a plan for schools and children who have missed out on a year of education? How will orphaned children who have been left on the streets be reintegrated into communities? Does Sierra Leone need a form of Marshall Plan for reconstruction? What is DFID doing?
- What is DFID and international community doing to improve the international response for future disease outbreaks? The Committee recommended an urgent review of the WHO, has that happened?
- What is the UK doing on drugs, especially in relation to antimicrobial drug resistance?
- FGM in Sierra Leone came to a halt during the Ebola crisis; how can the practice be prevented from coming back?
Relevant Sustainable Development Goals
7.The Sustainable Development Goals have been agreed by the international community to provide the foundation for international development over the next 15 years. As such, we will use the Goals as a foundation for our work over this Parliament, to consider how well DFID is performing in its implementation of the Goals. The Goal most relevant to this inquiry is:
- Goal 3—Good health and well-being—Ensure healthy lives and promote well-being for all at all ages.
- 3.3–By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases.
- 3.8–Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.
- 3.c–Substantially increase health financing and the recruitment, development, training and retention of the health workforce in developing countries, especially in least developed countries and small island developing States.
- 3.d–Strengthen the capacity of all countries, in particular developing countries, for early warning, risk reduction and management of national and global health risks.8
1 World Health Organization, ‘Ebola Situation Report - 30 December 2015’, accessed 31 December 2015
2 Q49
4 International Development Committee, Sixth Report of Session 2014-15, Recovery and Development in Sierra Leone and Liberia, HC 247
5 International Development Committee, Fifth Report of Session 2014-15, Strengthening Health Systems in Developing Countries, HC 246
6 International Development Committee, Eighth Report of Session 2014-15, Responses to the Ebola crisis, HC 876
7 House of Commons Science and Technology Committee, ‘Science in emergencies: UK lessons from Ebola inquiry’, accessed 31 December 2015
8 United Nations, ‘Sustainable Development Goals’, accessed 16 December 2015
© Parliamentary copyright 2015
Prepared 14 January 2016