Science in emergencies: UK lessons from Ebola Contents

1Introduction

1.Ebola virus disease is an acute, severe illness in humans which is often fatal if left untreated. Transmission can occur via contact with “the blood, secretions, organs or other bodily fluids of infected people, and with surfaces and materials (e.g. bedding, clothing) contaminated with these fluids”.1 In late 2013, an outbreak of Ebola began in Guinea. It was to become the largest, and most complex, on record. The World Health Organization (WHO) estimates that there have been over 28,500 confirmed cases since the start of the outbreak and more than 11,000 deaths.2

2.Almost all of these cases occurred in the West African states of Guinea, Liberia and Sierra Leone; three countries which had only recently emerged from long periods of conflict and political instability (see map)3. The outbreak was, first and foremost, a human tragedy. Ebola ravaged communities, causing untold suffering while placing local health systems, services and infrastructure under extreme strain. Amidst this turmoil, people throughout the affected region and beyond put their lives at risk to help others tackle a disease for which there is no licensed vaccine or treatment. We wish to pay tribute to all those who worked tirelessly to tackle this outbreak, many of whom put their own lives at risk, and many of whom are continuing their work today, fighting to avert similar crises in the future.

3.The Ebola outbreak, however, also exposed serious shortcomings in the international community’s emergency response to a global health crisis. Criticism has been primarily targeted at the performance of the WHO and its failure to act sooner. As far back as March 2014, Médicins sans Frontières (MSF - Doctors Without Borders) established its first clinic in Guéckédou, Guinea and warned that its volunteers were “facing an epidemic of a magnitude never before seen in terms of the distribution of cases in the country”.4 By June 2014, MSF reported that the epidemic was “out of control” and that the organisation had “reached the limits” of what its teams could do.5 Nearly two months later, on 8 August 2014, the WHO declared a ‘Public Health Emergency of International Concern’ for only the third time in its history and began to mobilise an international response to address the Ebola epidemic.

4.In the 2010-15 Parliament, the House of Commons International Development Committee (IDC) examined Responses to the Ebola crisis, focusing on the Department for International Development’s (DFID) actions to tackle the outbreak, as well as the role of the WHO more broadly.6 The IDC has since followed up on this work, conducting detailed scrutiny into what DFID, the WHO, and the international community more generally, are now doing to improve the international response to future disease outbreaks. Less attention, however, has been focused on the UK’s response to Ebola either domestically, or in Sierra Leone, where the UK took the international lead in providing assistance, committing £427million to combat Ebola.7

Our inquiry

5.The UK should be proud of its efforts in responding to the Ebola crisis, from establishing treatment centres and training frontline healthcare workers, to fast tracking human trials of an Ebola vaccine and boosting the capacity of burial teams to respond quickly, while ensuring dignified burials. Complacency on the part of the Government, however, must not be allowed to set in. While there were certainly ‘success stories’, these should not obscure the fact that Ebola damaged communities, compromised essential public services, weakened economies, and led to thousands of deaths in West Africa. It is vital that we learn lessons now if we are to take the necessary steps to prevent an outbreak causing such havoc and devastation in the future.

6.We therefore decided to examine the UK’s response to Ebola focusing particularly on the mobilisation of treatment, research, scientific advice and of expertise in tackling this type of overseas disease emergency.

7.On the 20 July 2015, we announced our inquiry and sought written submissions addressing the following points:

a)How prepared is the Government for a similar type of emergency? Is it effectively mitigating and increasing resilience to the disease hazards identified in the National Risk Register?

b)What lessons were, or should have been, drawn from the Ebola emergency for gathering, assessing, using and communicating scientific advice across Government during this type of emergency?

c)How successful was the Government in communicating advice to the UK public about the emergency?

d)Since the Ebola emergency, how well has scientific advice been used to inform or revise the Government’s planned response to similar emergencies in future?

e)Could the evidence base and sources of scientific advice to Government on emergency mitigation, planning and response be improved? If so, how?

f)What are the strengths and weaknesses in the system for weighting the risk of a future Ebola-type emergency, including the possible scale of impacts for the UK and their likelihood?

We received 18 written submissions and took oral evidence from 17 witnesses from a variety of backgrounds including:

We also held a seminar at the University of Oxford (see Annex). We would like to thank everyone who contributed to this inquiry.

8.In our inquiry, we have been primarily concerned with the science aspects of the UK’s response to the Ebola emergency and the lessons that we must learn for the future. We have not focused on the role of DFID and the humanitarian response as this has been scrutinised on multiple occasions by the IDC. Instead, steps to increase the UK’s preparedness for major disease outbreaks are considered in Chapter 2, while Chapter 3 examines the strengths and weaknesses of the UK’s response, both domestically and in Sierra Leone. Finally, Chapter 4 looks at how emergencies are governed, from both an international and national perspective, the latter focusing particularly on the UK’s global health policy.

9.While our report is focused on how the UK can improve its response to ‘disease emergencies’, our recommendations do not suggest that the UK’s longstanding efforts to reduce the global burden of chronic and endemic diseases should be accorded a lower priority. Affected West African states began to be declared Ebola-free by the WHO during the course of our inquiry, yet chronic and endemic diseases persist globally. Diarrhoeal disease, for example, is one of the leading causes of death in children under 5 years old, killing an estimated 760,000 annually across the world. Most of these cases could have been prevented through access to safe drinking water, better sanitation and improved hygiene.8 The recommendations in our report should be pursued alongside such interventions.

1 World Health Organization, ‘Ebola virus disease’, Fact sheet N°103, Updated August 2015, accessed 14 December 2015. The WHO is the international body responsible for the promotion and protection of health globally.

2 World Health Organization, Ebola situation reports, December 2015

3 Outbreak distribution map produced by the US Centers for Disease Control and Prevention based on data from the World Health Organization Ebola Situation Report, 6 January 2016.

4 Guinea: Mobilising against an unprecedented Ebola epidemic, Médicins sans Frontières Press release 31 March 2014

5 Ebola in West Africa: “The epidemic is out of control”, Médicins sans Frontières Press release 25 June 2014

6 House of Commons International Development Committee, Eighth Report of Session 2014–15, Responses to the Ebola crisis, HC 876

7 HL Deb, 21 July 2015, HL1280 [Lords written answer]

8 World Health Organization, Diarrhoeal disease, Fact sheet N°330, April 2013 accessed December 2015




© Parliamentary copyright 2015

Prepared 21 January 2016