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Ebola Response Update

Volume 649: debated on Tuesday 20 November 2018

With permission, Mr Speaker, I will make a statement on the current outbreak of Ebola in the Democratic Republic of the Congo and how the UK Government are continuing to support the response and preparedness activities in neighbouring countries.

Miraculously, I have put on a different hat. Since the last update to the House on 10 October by my right hon. Friend the Secretary of State for International Development, the number of confirmed Ebola cases in this outbreak has continued to rise. As of 18 November, there were 326 confirmed cases and a further 47 probable cases, making this Ebola outbreak the biggest in the history of the DRC.

The DRC Government are leading the response with the support of the World Health Organisation. The DRC Government issued a revised response plan in late October, which projected that the outbreak would be contained and declared over by the end of January 2019. However, it is now clear that that will take several more months to achieve.

The WHO judges that ending the outbreak could take a further six months, under a best-case scenario. That reflects the very challenging operating environment in eastern DRC, which is a heavily populated area affected by insecurity. For example, last weekend an attack by armed groups on a MONUSCO base was close to where a vaccination team were staying. Thankfully, none of the Ebola responders was injured, but they were moved to Goma for a short period and vaccination activities had to be paused for a day.

The scale of the response is also challenging. In addition to the 373 confirmed and probable cases, the DRC Government, supported by WHO and other implementing partners, is trying to trace some 4,400 contacts on a daily basis.

However, there is some encouraging news. The response is enabling faster detection of cases, laboratory diagnosis and monitoring of the spread of the disease. The WHO-led support is improving Government medical facilities and their capacity to manage patients and treat them safely. That includes vaccination of health workers, provision of personal protection equipment, and advice on safe practices for dealing with suspect and confirmed cases. Part of the response involves raising awareness of the disease within local communities and putting in place measures to prevent cross-border spread. So far, 110 people have recovered.

The UK responded quickly to support the international response as the second largest donor to the strategic response plan, as well as deploying epidemiological experts to support the WHO response on the ground. UK support has helped to improve leadership and co-ordination, surveillance, infection prevention control and preparedness measures.

In view of recent developments, we have increased our support for the response and preparedness activities in DRC and neighbouring countries. Our funding will support a range of activities including surveillance, vaccinations, infection prevention and control, community engagement and safe and dignified burials.

In addition, the UK is supporting neighbouring countries to prepare to tackle the disease should it spread, by funding key UN posts in Uganda, Rwanda, and South Sudan to ensure they are as prepared as possible. We are applying the lessons of previous experience in tackling Ebola. An experimental vaccine, the development of which was supported by UK aid following the west Africa outbreak, is being given to frontline health workers and contacts of confirmed cases. In the DRC, over 31,000 people, more than 10,000 of whom are health workers, have already been vaccinated during this outbreak. The UK is also supporting training in preparation for clinical trials of several of the new therapeutic drugs for Ebola.

The UK Government are also drawing on all available scientific data about the latest outbreak. We will continue to liaise closely with WHO and others to ensure that the available scientific evidence is reflected in scenario planning. An international Ebola preparedness and co-ordination meeting is due to take place in Goma shortly, which will be attended by Ministers from the DRC and Uganda, to discuss cross-border co-ordination.

So far, the UK has contributed £25 million to the Ebola response. This is supporting WHO to work on screening, surveillance and preparedness, not only in the DRC but in neighbouring countries. Of this, some £20 million is from the crisis reserve of the Department for International Development, and £5 million is from the country budget for Uganda. When I visited Uganda last month, I saw how UK aid is helping the Uganda national taskforce to be ready to deal with Ebola, as needed.

It is clear that the response will require a sustained effort over time and additional resources. The UK Government stand ready to provide additional assistance. Therefore, we have agreed a further £20 million from our central crisis reserve in 2018-19, to support Ebola responses in the affected region.

I am sure that my colleagues in the House will recognise the risk that Ebola responders face. The DRC Government have asked donors not to publicise figures for specific activities, to avoid putting implementing partners at risk from criminal elements. I hope that the House and members of the press will respect the need for discretion about this issue. Public Health England assesses the risk to the UK of this outbreak as negligible to very low. It will continue to monitor and assess the outbreak closely. Should that risk change, the UK Government remain at full readiness to respond, and I commend this statement to the House.

First, I thank the Minister for giving me advance sight of her statement. I share the Government’s deep concern about the outbreak of Ebola in the Democratic Republic of the Congo, and I am pleased to hear that £25 million of UK aid has been given to the response. We hope that it goes some way to containing this deadly outbreak.

In addition, supporting neighbouring countries to prepare to tackle the disease is fundamental and welcome. In 2014, we learned the hard way what happens when action is not taken fast enough to halt the cruel and deadly Ebola virus. We all remember with great sadness how too many people tragically lost their lives in west Africa, and none of us will ever forget the fear and chaos that the virus wreaked on the affected communities, and indeed right across the globe. I am sure we all agree that we must act now to avoid a repeat of those horrific scenes, and help the DRC to contain this outbreak.

With the World Health Organisation reporting that 213 people have died since 1 August in the DRC, and the humanitarian agency Médecins sans Frontières confirming 366 cases, let us be sure that DFID steps up and ensures that the UK plays a crucial leadership role alongside the international community in responding to this outbreak, just as we did in Sierra Leone four years ago.

However, while emergency humanitarian response is an integral part of DFID’s work, I am sure the Minister agrees that prevention is better than emergency response. While we send aid to DRC, we cannot and must not turn our backs on providing the long-term support that will ensure countries across the global south have appropriate health systems set up in the first place.

It is deeply disappointing, therefore, that the Minister’s Department dropped health spending from 18% of DFID spend in 2014, to 12% in 2017. Meanwhile, spending on banking and financial services has been on the increase, as the Department appears to lose sight of its core work and instead increases spending on promoting private companies to expand their profits.

Just this year, the aid watchdog, the Independent Commission for Aid Impact, told DFID it really needs to improve its work on strengthening health systems. May I ask the Minister, therefore, if she feels that her Department has learned the lessons of the 2014 Ebola outbreak, and recognises that supporting countries to build strong, well-managed public services is the only way to ensure that we will not see these outbreaks again in the future?

I will come on to the lessons learnt since the outbreak in Sierra Leone in a moment. However, I am sure that I cannot possibly have heard from the Opposition Front Bench a statement to the effect that having a strong private sector is somehow in conflict with having the revenues needed to provide strong health systems around the world. I hope that that is not the considered position of those on the Labour Front Bench. While spending on strengthening health systems around the world, particularly in some of the poorest and most fragile affected countries, it is important that we in the UK recognise the important role of growth and job creation in the ability of those countries to generate their own tax revenues so that they can continue to strengthen their own health systems. We think that that is the most important way to approach worldwide development.

I digress from the topic at hand. The hon. Lady mentions the outbreak in west Africa. I draw the attention of the House to progress and lessons that have been learned since that outbreak. First, the importance of reacting quickly has been taken into account, both in the first outbreak in the DRC earlier this year, which I am glad to say has been brought under control, and in this outbreak. Importantly, the UK has ensured that the WHO has the resources it needs as soon as it needs them, because this is a clear case of where a quick reaction will save lives.

One major milestone that has occurred since the outbreak in west Africa is that the world has developed an experimental vaccine, which was deployed for the first time this year in the DRC. It proved to be effective in the first outbreak. As I said, 31,000 people have been given the experimental vaccine so far in this outbreak. One real challenge, however, is that this outbreak is in a conflict-affected area. That makes it very difficult to trace contacts and, as I mentioned, 4,400 contacts need to be traced daily. It also makes it very difficult to deliver the vaccine. The vaccine requires trained medical professionals to deliver it. It also requires a secure cold chain. The fact that this is a conflict-affected area is therefore significantly hampering the ability of the international community to do what it needs to do.

The third lesson learned from the outbreak in west Africa is that the WHO strengthened its own processes and has worked with a range of different countries to strengthen their health processes. Ensuring resilience in neighbouring countries is very much a part of the response at the moment—this outbreak is not far from the Ugandan border, just some 20 miles inside the DRC. Strengthening the reaction and response at borders is a lesson that has been learned.

Order. There is some interest in this matter. We appreciate both the Minister’s statement and her desire to provide comprehensive replies, but I remind the House that there are several hours of debate upcoming on the Finance Bill and before we even get to that we have a further statement to follow. I want the next statement to start at two o’clock, so we need short questions and very short answers.

The Minister mentions Uganda, Rwanda and South Sudan. It is a good idea to be investing in those countries, but has the Minister also considered investing in Burundi, particularly given the economic and political instability, and the poor health system in that neighbouring country?

My hon. Friend is absolutely right to think about the implications further south. This outbreak is happening closer to the Ugandan border, but he is absolutely right that in due course it may be important to consider the impact on Burundi. He will be aware of the current very difficult situation for international non-governmental organisations in Burundi. Some NGOs have been asked to leave the country and the UK remains concerned about its ability to work with them there. However, I take on board his point that, should there be further movement to the south, it will be very important to ensure preparedness extends to Burundi.

I thank the Minister for advance sight of her statement on what is a particularly unpleasant and serious illness. I was grateful to hear her update on the resources that are being provided to deal with the DRC’s largest ever outbreak of one of the most deadly strains of Ebola. I was also grateful to hear that increased support is being provided.

Can the Minister advise me on how many people are working in the region as part of the UK public health and support team? What measures are in place to protect their safety in what is effectively a war zone? It is estimated that more than 100 armed groups are active in the territory of North Kivu. A number of attacks in this province where Ebola has been witnessed are seriously hampering the Ebola outbreak response activities. What is being done to address such issues around instability, which are affecting the efforts to control the outbreak?

Finally, while I welcome the update on the numbers of people who have been provided with the experimental vaccine, may we have an update on the clinical trials of several new therapeutic drugs for Ebola that the Minister’s Department is supporting training for?

I welcome the hon. Gentleman’s comments. I want to reassure the House that from the very get-go—both with this outbreak and in the earlier outbreak—the UK made it clear that we will provide resources. What we really need is for the WHO and the DRC Government to co-operate on delivering them. He will be aware that some very brave people from Public Health England were able to fly out to the first outbreak, when the experimental vaccine was deployed for the first time. I want to take this opportunity to pay tribute to their amazing bravery, and indeed to the bravery of all health workers involved in this particular deployment.

I would also like to underline the other ways in which the UK is providing support. Financial support is obviously important, as was the initial support from Public Health England in terms of the cold chain. We helped to develop the vaccine and we also help in terms of widespread support to the health systems in poorer countries, including the DRC, where I was able to see some of the work that we have helped to support. We also support the MONUSCO peacekeeping operation, so there is a wide variety of ways in which the UK helps.

On the hon. Gentleman’s specific point about other experimental vaccines that we may be investigating, I will write to him.

Victims are at their most infectious when they are dead. A key intervention in Sierra Leone was burial teams; are they being deployed in the Congo?

My right hon. Friend is always a model of brevity. I can assure him that in my perhaps too verbose statement, I drew attention to the fact that we are supporting safe burial practices.

Does the Minister recognise the importance of the work in this field of Professor Tom Solomon of the University of Liverpool, and of the Liverpool School of Tropical Medicine? Will she continue to support international funding so that their efforts, as part of a comprehensive approach to deal with this disease, are supported?

The hon. Lady is absolutely right to draw attention to the very important role that these key partnerships play around the world in strengthening health systems. She mentioned Liverpool which, as the House will know, does amazing work in this area and on neglected tropical diseases. When I was in Uganda, I saw the incredibly strong partnership between the Uganda Virus Research Institute and the University of London through its London School of Hygiene & Tropical Medicine. Those incredibly important partnerships are a win-win for the developing world, and a win for the UK.

I declare an interest as a trustee of the Liverpool School of Tropical Medicine. Has my hon. Friend found that the amazing expertise gained by her Department as a result of that tragic situation in 2014 has been retained and enhanced in the meantime, or are we having to learn things again?

I mentioned some of the ways in which knowledge of dealing with these outbreaks has been acquired and improved on as a result of the outbreak in west Africa. Much of the expertise in Public Health England was drawn on very early in the previous outbreak in the Democratic Republic of the Congo. I reiterate that the response is running into challenges not because of a lack of expertise, a lack of vaccine or a lack of dedicated personnel willing to deliver it, but because of the conflict on the ground. People are attacking peacekeepers in the area. Therefore, we call on all participants to eschew violence and allow health workers to do the job that they need to do, because that is the real threat in this outbreak.

According to Médecins Sans Frontières, the delay in recognising the latest outbreak is in part due to a strike by health workers in the area over non-payment of salaries. Will the Minister elaborate on what her Department is doing to support the functioning of the health service in that country?

I pay tribute to the amazing work done by Médecins Sans Frontières, which is part of the delivery mechanism for the response. We have been very pleased with the co-operation that we have had from the DRC Government and their health system but, as the hon. Lady will know, that country is enormous. It is extremely heavily populated and conflict is being experienced in this particular area. Those factors, rather than a willingness of spirit or the desire to help, are the particular challenges in this outbreak.

To what extent does my hon. Friend think that the security situation is hampering efforts to treat people in the region, and what are the solutions?

I underline that that is the fundamental challenge in the outbreak, because it has made it very difficult to trace contacts—I mentioned that over 4,000 people who are contacts of people who have tested positive for the disease need to be traced every day—and it is making it really difficult for health workers to do their job. The fact that MONUSCO has come under attack in the area underlines the very fragile security situation, which is causing untold harm to the response.

The Minister mentioned the fragile security situation, and we know that the US Government will not allow their employees to go near the epicentre, because it is unstable. What assessment have the UK Government made of the security of UK employees there and of the circumstances in which they will be able to continue to work?

I draw the hon. Lady’s attention to the remark that I made towards the end of my statement, which was that, with respect to the House, we do not feel that it is helpful to the security of the individuals involved to comment on any specifics about the people who are currently working in that region on behalf of the UK Government.

I thank the Minister for the decisiveness of her Department’s response. Is she satisfied that all precautions are being taken to ensure that the disease is contained and not inadvertently exported to nearby countries or, indeed, even further afield by plane?

I thank my hon. Friend for his kind words. We constantly ask ourselves that question and we constantly ask our interlocutors from the relevant neighbouring countries whether there is anything else that should be done or that we can do to help. For example, when I was in Uganda, I was able to ask its Prime Minister whether the country would be able to approve the use of the experimental vaccine through their procedures as quickly as possible. I am glad to report to the House that, following that intervention, it has now been approved for use within Uganda.

I welcome the overall tone of the Minister’s statement. We previously saw with Operation Gritrock how our military, in an unarmed capacity—providing logistics and medical support—could make a real difference to fighting Ebola. What discussions has my hon. Friend had with the Ministry of Defence about how some of those capabilities could be used, given the situation on the ground?

My hon. Friend is absolutely right to pay tribute to the amazing work that UK forces did in Sierra Leone—words fail me in describing the amazing bravery that they showed in dealing with that outbreak. This particular example is within the boundaries of the Democratic Republic of the Congo, which is working with the forces that it believes are appropriate for that area. It is probably worth my saying on record that were the Government of the DRC to want to explore that approach with our Ministry of Defence, we would obviously be very happy to have that conversation.

Given that it might take up to six months to contain the outbreak, what extra resource is being deployed by other major EU countries? Does that match up to the UK’s response?

I think I said that that was the best possible scenario. I reassure my hon. Friend that while the UK is the second largest contributor to funding the response so far, the World Health Organisation’s plan is fully funded, and other countries have stepped up to the plate to fund it. The issue is not a lack of funding or a lack of willingness from the international community to help out, and nor is it a lack of co-operation from the DRC Government in terms of the way in which the outbreak is continuing to grow. The issue is particularly the fact that this is a conflict-affected area, and that is hampering health professionals’ ability to do important work.

As my hon. Friend will know, the Democratic Republic of the Congo is one of the largest countries in Africa. Physically, it can sometimes be difficult to travel on the roads, and communications can be more challenging than they would be if such an outbreak happened here in the UK. The current outbreak is in the area of Beni—the previous outbreak happened in a completely different part of the DRC—which is 20 miles from the Ugandan border. Physically, the area is quite large and people also move, which is why it is important to trace the contacts that people have had, because those contacts can move easily across the country and across borders.

Can my hon. Friend confirm that the actions of her Department are not only keeping people in the affected area safe but helping to keep UK citizens safe?

I can absolutely confirm that. I mentioned that Public Health England believes that the risk to the UK population is currently low, but obviously people travel around the world, and in this interconnected world, I strongly believe that a healthier world means a healthier UK.

The Minister has said repeatedly that the conflict has prevented efforts to contain the outbreak. What steps can the UK Government take to help bring the conflict to a rapid conclusion?

As my hon. Friend will know, there are many sources of conflict in the DRC. The UK, as a leading member of the UN, is a significant funder of the UN peacekeeping operation, MONUSCO, which has been there for a long time. Obviously, the UK supports it proportionately alongside our other obligations at the UN.

World Health Organisation officials had to leave following an attack on a hotel in the Congo. Does the Minister anticipate more UN peacekeepers being in place to help officials stay in post?

I would like to put on the record my appreciation for the work of the MONUSCO peacekeepers in this very dangerous part of the world. Far too many of them have been victims of violence while doing their job. Given how prone this part of the Democratic Republic of the Congo is to violence and conflict, it is important that the relevant Government authorities work with MONUSCO to take whatever steps they believe necessary to protect those peacekeepers and ensure that the appropriate forces are there.

Terrorists and refugees are extremely mobile. How adequate are the plans the Minister has announced for neighbouring countries to meet that challenge?

My hon. Friend is right to draw attention to the risk of this outbreak being contagious across borders, given how close it is to the Ugandan border. The WHO and others are working with neighbouring countries to make sure that people are screened at the border, that there is a sufficient supply of vaccines and, as I mentioned earlier, that vaccines are approved for use within countries. We are taking all the steps we can, but what makes this outbreak so challenging is, as he rightly says, the prevalence of violent individuals disrupting the work of the health workers and peacekeepers.

With the outbreak predicted not to be under control for another six months, can my hon. Friend please assure us that everything is being done to protect our vital and much-valued health workers? Without them, we cannot deliver the programme, and with them, the consequences could extend far beyond the Congo. Will she join me in thanking these very brave workers?

My hon. Friend makes my point incredibly eloquently. I mentioned that 31,000 health workers, I think, had received the experimental vaccine so far. Think about how brave they have to be to receive an experimental Ebola vaccine; I do not like getting my flu jab. I therefore want to take this opportunity to draw the House’s attention to those strong words of appreciation for the brave work of both the peacekeepers and the health workers.

As the Minister has just made clear, the outbreak is less than 20 miles from the Ugandan border, which is incredibly worrying. What practical help and support are the Government giving to the Ugandan Government to prevent what would be a major crisis should this cross the border into Uganda?

I had the great pleasure of visiting Uganda and was thoroughly impressed by the work of the Uganda Virus Research Institute and the reassurances I got from across the Ugandan system about its increased preparedness for the risk of Ebola crossing the border. People there had, for example, made sure the experimental vaccine was approved by the appropriate Ugandan authorities.