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Volume 756: debated on Thursday 6 November 2014

Question for Short Debate

Asked by

To ask Her Majesty’s Government what assessment they have made of the international response to Ebola.

My Lords, at the outset I must pay tribute to the considerable contribution that the United Kingdom and its NGOs, health workers and service personnel are making in efforts to respond to the Ebola crisis. Despite those and other great efforts, as the world now knows, Ebola continues to destroy lives, livelihoods and communities. It impairs national economies and is severely damaging what are already very fragile basic services. It is reversing years of development efforts with devastating effects and there is a danger that this epidemic could undo years of efforts to stabilise the west African region and lead to new tensions between neighbouring countries.

Against that background, does the Minister agree with Kofi Annan, who has said that:

“If the crisis had hit some other region it … would have been handled very differently”?

He went on to say:

“When you look at the evolution of the crisis, the international community really woke up when the disease got to America and Europe”.

That judgment is echoed by Dr Chan, the director-general of the WHO, who has emphasised,

“the dangers of the world’s growing social and economic inequalities”.

She said:

“The rich get the best care. The poor are left to die”.

Hearing that, does the Minister agree that Ebola is tragically highlighting the basic reality that Governments and commerce must give higher priority to investment in the prevention of disease in developing countries? Should donors not be spending much more on global health, including overcoming malaria, TB and HIV, when those plagues are fundamental causes of underdevelopment and when more has to be spent on treatment simply because too little is still being invested in prevention?

We surely need to deal now with the reality that the world has simply not prepared itself for an effective response to any severe, sustained and contagious health emergency. The progress which is claimed by some to be taking place is, to say the least, uncertain. Experts grimly tell us that we are not close to reducing mortality or stopping Ebola’s transmission, which will not happen for some time. On just one day this month, 2 November, 61 new cases were reported across Sierra Leone, bringing the nationwide toll to 4,059 cases. According to Save the Children, five people are being infected every single hour in Sierra Leone.

However, Ebola emerged 40 years ago, so why after four decades of huge scientific advance is there no vaccine and no cure? Could it be because Ebola has no R&D incentive for a profit-driven global pharmaceutical industry? Professor Peter Piot, the director of the London School of Hygiene & Tropical Medicine, who is of course the scientist who first identified Ebola, has said that it would not have been difficult to contain the outbreak if those on the ground had acted quickly. He has also said, however, that tragically:

“Something that is easy to control got completely out of hand”,

as isolation, care and tracing and monitoring contacts, which have worked before, will not prevent the spread now. He went on to say:

“It may be that we have to wait for a vaccine to stop the epidemic”.

The awful truth is that no one knows the real death toll in Sierra Leone. We do know, however, that there is the most terrible suffering and misery. I will give just one all-too-typical instance. A woman with a nine year-old child and a six year-old child lost her husband to the disease. Naturally, she had nursed him. Now she is dead and both children have Ebola. They are orphans and victims. But hugging loved ones should not be a death sentence. Obviously, as in every culture, the women of west Africa are the carers of their families. They are consequently the front-line health workers who are most exposed to and affected by Ebola. In fact, in Liberia, 75% of those infected with or killed by Ebola are women.

Even before this crisis Sierra Leone had one of the world’s highest maternal mortality rates. Now, because of the collapse of healthcare and the fear of contracting Ebola in hospital, many more women are dying in childbirth because they are afraid to go to hospital. Donors, including the UK, clearly need to take account of the higher risk that women and girls face of getting Ebola. In addition, priority should be given to sexual and reproductive healthcare, and it is vital that there is a proper response to the increased vulnerability of women and girls to violence during the Ebola crisis. Can the Minister tell the House whether efforts are being made to ensure that women are engaged at national and community level in shaping responses to this crisis?

After years of devastating civil wars, already fragile basic services are now desolated. In Sierra Leone, nearly 40% of the population do not have access to clean water and sanitation is worse than rudimentary. As a result, maintaining the level of hygiene needed to prevent the further spread of a virus which is transmitted through contact with body fluids is extremely difficult, and clearly the lack of basic services is putting at risk the lives of all those who care for Ebola patients. There is surely a need to make systematic and rapid efforts to ensure universal access to these basic services in all the hospitals, homes and schools. Without that, a future public health catastrophe is inevitable. In addition to addressing the response being made to inhibit the current epidemic, can the Minister clarify whether the Government are making a long-term response to the Ebola outbreak in west Africa that promotes the systemic changes required to deal with any future outbreaks?

The president of the World Bank has said that:

“We were tested by Ebola and we failed … miserably in our response”.

He then asked:

“Why don’t we have a multibillion dollar fund of $10bn, $15bn or $20bn … so that once there is a global health emergency it can be drawn down on … quickly?”.

He is surely right to ask that question, so what is the answer from our country and our Government? Are we going to try to win this battle or will we actually fight to win the war?

My Lords, I congratulate the noble Baroness on that quite excellent speech, with which I very much agree. Quite apart from the present effort to deal with the Ebola crisis, I will emphasise just two points on future policy.

The first is that the Ebola crisis again illustrates how deficient the health systems are in so many countries, not least in Africa. There is a lack of doctors and nurses; there is a lack of equipment and of modern buildings. Their health systems are under enormous pressure in what could be termed normal times, let alone abnormal times. Nothing is more urgent than that British aid policy should be directed here. That will also have the effect of tackling other scourges such as AIDS, which even today accounts for more than 1.5 million deaths a year, many of which are, of course, in Africa.

My second point is that if we are to help further, we need to look again at our policy of recruiting medical staff for the National Health Service from some of the poorest countries in the world. The latest figures that I have are that 21,000 National Health Service staff had their primary medical qualification in Africa, including almost 600 from Sierra Leone. This is in no way a criticism of them but we should examine our policy to see that we are not taking medical staff from countries which have trained them and whose need is much greater than our own here. Our aim should be to be self-sufficient and for us to provide more training in those countries which are undoubtedly in the greatest need around the world.

My Lords, I congratulate my noble friend Lady Kinnock on having introduced this debate so ably. I confine myself to posing a number of questions to the Minister.

First, there are signs that the number of new cases of Ebola in west Africa is levelling off—especially in Liberia, less so in Sierra Leone. Do the Government have a view on this? If so, I hope they will bear in mind the words of a seasoned observer who said, “I’m terrified that the information will be misinterpreted”—in other words, that relaxation will follow. It absolutely must not.

Secondly, could the Minister comment on the secondary health crisis fast developing in west Africa, alluded to by the noble Lord, Lord Fowler? This is the result of already rudimentary medical resources being concentrated on Ebola. It involves a surge in cases of untreated malaria as well as other serious health hazards. Large-scale resources need to be injected here—and very rapidly. Where will they come from? Are the UK Government contributing?

Thirdly, these problems add to the horrendous economic costs of the Ebola epidemic to already impoverished societies. The damage inflicted to date is estimated at $32 billion in Liberia and Sierra Leone alone. How can we counter the very real danger that, if and when Ebola is contained in west Africa, the rich countries of the world will lose interest? What representations are the Government making to the World Bank and the IMF on this issue?

Fourthly and finally, the threat posed by Ebola to countries with advanced health systems is low. However, would the Government agree that a certain level of global risk remains? The key country in question is China, given its extensive involvements in west Africa. Some 9,000 people from areas where Ebola is concentrated have entered Guangdong alone since August. The standard of care in Chinese hospitals is quite low. Perhaps the noble Baroness would like to comment on that.

My Lords, for almost a decade I was responsible for managing major infrastructure projects along the Guinea/Sierra Leone/Liberia border. Only 5% of Sierra Leone’s highways are paved and the rest of the network is gravel, generally poorly maintained. We are nearing the end of the rainy season, and in the interior some rivers will have flooded and roads and minor bridges will have been washed away, isolating many communities. In yesterday’s Disasters Emergency Committee briefing, it was clear that it had yet to reach the remote areas of Guinea.

Visiting American envoy Samantha Power has lambasted the international community for not supplying aid, doctors and health workers to an area where hundreds of thousands of people can rely on perhaps only a handful of clinicians for their health needs. As she boarded a plane for Guinea, she said:

“You have countries at the United Nations … who are signing on to resolutions and praising the good work that the United States and the United Kingdom … are doing, but they themselves haven't taken the responsibility yet to send docs, to send beds, to send … money”.

The international community,

“isn’t just losing the race to Ebola. We are getting lapped”.

Both the DEC and the UN admit that Ebola cases are doubling every three to four weeks, with the potential to reach 1.2 million. The WHO says that, unless the rate of infection reduces by 1 December, it will be overwhelmed by,

“an entirely unprecedented situation, for which we do not have a plan”.

At present, less than a quarter of the almost 5,000 planned Ebola treatment beds are operational, due fundamentally to a lack of foreign medical teams. Lack of bed space has become a huge issue.

What is desperately needed is the development of community health systems, which expand and grow from the bottom up in the communities and settlements in the interior. Dependency on outside intervention leaves the people hostage to fortune in terms of accessibility by road, particularly in the rainy season.

In this regard, what precisely are the special resources that NATO is able to bring? Does NATO have the thousands of clinicians and aid workers that might turn the tide? I some how doubt it.

My Lords, I suggest that the current crisis indicates the great wisdom shown by the coalition Government in dedicating a higher proportion of GDP than any other developed nation towards international development. Their leadership is admirable and much to be commended. This is a time when our economy is growing and unemployment is much better than other nations, so it is not too costly to do.

I ask the Minister how much funding the Government are providing for UNICEF in dealing with these issues and whether more can be done. UNICEF highlights that one in five Ebola patients are children. At least 3,700 children have been orphaned by the disease and 8.5 million children and young people under the age of 20 live in affected areas. Many schools are closed and, in terms of the breakdown in the healthcare services, children do not receive vaccinations and necessary preventive care for common childhood illnesses. More and more children are dying of malaria, for instance, because the facilities are not available. Also, the fear of seeking treatment at medical facilities means that deaths from malaria, pneumonia and diarrhoea could well outstrip those from Ebola three or four times.

A very difficult child protection issue is becoming apparent, with the preliminary figure of at least 3,700 orphans—the real number may be much higher—who have lost one or both parents. In addition to facing the challenge of growing up without parents, they may face further stigma or discrimination from their communities or families. Children who lost relatives to the disease are often ostracised, even if they were tested negative—there are reports of children being treated in this way. Those who have been orphaned by Ebola are even more so, because of the nature of the challenges they face: they risk both infection and rejection. They risk infection because they have been exposed directly to the virus through their parents and they face rejection because others around them, whether relatives, friends or community members, may be too afraid to go anywhere near them.

UNICEF is doing very important work in this area. It has made an appeal for £120 million and has only achieved 35% so far. I look forward to what the Minister has to say.

My Lords, I would like to begin by praising the Government’s generous and effective response to this crisis. The opening of the Kerry Town clinic in the last day or two shows the dedication and efficiency of our troops at their best. I hope that the Minister will pass on our congratulations on that. Even more praise should go to healthcare workers from this country who have volunteered and are active in Sierra Leone at the moment.

I do not think that we should be so impressed with the World Health Organization. Despite its history of overreaction to swine flu in Mexico in 2009, on this occasion it has been dangerously complacent for far too long. In March it contradicted Médicins Sans Frontières when it said that this crisis was getting out of control, saying that it was not. Only in June did it call a meeting of its global outbreak alert committee and it only declared an emergency in August. The danger is that if an international agency of this kind is not worried, then the rest of the world does not follow suit. It has a unique responsibility to get this kind of thing right. The world cannot be expected to respond appropriately if it is not getting those kinds of signals.

I can see why the World Health Organization thought that this problem was containable. The previous 33 epidemics of Ebola have all been relatively easily contained. What it overlooked, of course, was the desperate poverty and the aftermath of warfare in this particular region and that individuals in those countries were being left to bury their own dead, with particular risks to them, and to treat family members.

Poverty is the scourge we need to eradicate if we are to prevent such outbreaks in the future. It is no accident that this outbreak has happened in three of the very poorest countries in the world. I ask that my noble friend looks very hard at the World Health Organization and lessons that must be learnt from this epidemic when the time is right. Were its priorities correct in this epidemic?

One final, different point is that this is a disease that is harboured largely by bats, as far we can tell. It is not the only one—rabies, Lyssavirus, Hendra virus, Nipah virus, Marburg virus and even SARS are harboured by bats. We need to draw on zoological expertise to try to understand why so many dangerous diseases are coming from bats.

My Lords, I draw attention to my interests declared in the register. In particular, I am a trustee of the Disasters Emergency Committee, which currently has an Ebola appeal to which the British public has responded to the tune of over £13 million within a week. Also, my husband chairs Restless Development, which is supported by DfID in its work in sensitisation and education in Sierra Leone.

I have two points. The first, which comes from the 11 DEC agencies working in the field, is about the breadth of the needs in these countries. Of course treatment and quarantine centres are essential, but if we are to stop the spread by stopping transmission we need to facilitate safe burial, education, water and sanitation kits and food for people who are in quarantine and who will otherwise leave it to get their own food. The range of humanitarian needs is enormous and will continue to be so, because of those orphaned children, because of those children who have not been educated since April and have no prospect of schooling, because of the women who are dying in childbirth and who will be leaving more orphans, because of the people with malaria who are not getting treatment and because of the vaccination programmes that are not taking place. So the scale and range of needs is going to be really long term.

The second point is one to which the noble Baroness, Lady Kinnock, referred. The reason why we do not have a vaccine for Ebola is not because it is a uniquely complex vaccine to develop. The reason why we do not have a vaccine for Ebola is the same as the reason why we do not have treatments and vaccines for other neglected tropical diseases: they are diseases of the poor, and we have a complete market failure in meeting them. We need to put more resources into developing vaccines and treatments, not only because of the humanitarian imperative but because we live in a global world and it is actually our best protection, as well as a humanitarian imperative, to use our expertise and resources to treat these diseases.

My Lords, this is a very important debate, and I regret that we have only one hour. The Ebola crisis is already a medical and humanitarian disaster. Thousands of lives have been lost, and tens of thousands are at risk if we do not act more effectively now. It is particularly tragic because over a decade of progress in Sierra Leone, Liberia and Guinea is under threat. In recent years, for example, Sierra Leone had halved the number of women dying during childbirth, but we now know that that is in reverse.

I am a trustee of a charity, the Africa Governance Initiative, which has teams of people working on the Ebola crisis in Sierra Leone, Liberia and Guinea. They are working alongside Governments and the international community to put in place the systems—command centres, hotlines and so on—to manage the response. They went to those countries to help build government capacity on other issues and reduce poverty. They did not expect to be dispatching ambulances and managing body disposal, but they have done so anyway and I am very proud of every one of them.

The UK Government’s commitments are welcome but I think they have been too slow, and we are not ensuring that there are sufficient doctors and health workers on the ground. There is a real imperative for us to do more on that. I am proud of another organisation that I am a trustee of, Voluntary Service Overseas, which this week—again, a bit late—has put out an appeal to all return volunteers who have a health qualification to volunteer to go and help with Ebola. However, even if every one of the 600 or so who have been asked were able to help, that would not be enough. There is a real imperative for us to get more people on the ground who are able to get on top of this crisis as quickly as possible.

If we do not get hold of Ebola, these very fragile states will become much more vulnerable and their ability to survive and look after their people will be lessened even further.

My Lords, the noble Baroness, Lady Kinnock, set out very cogently the big picture and the underlying issues. I want to pick up a small but important element in the international response. Let me say how good it is to see the UK leading the way but how disappointing it is to see that some other countries seem to have adopted a fortress mentality, which is short-sighted and contrary to both best practice and international agreements on tackling global epidemics.

I turn to my specific point. I declare an interest as chair of the King’s Centre for Global Health advisory board. King’s has been working in Sierra Leone for two years and is one of the very few organisations that stayed in the country when Ebola broke out. Its team has played a central role in the multiagency effort in the country, and now has very considerable experience. Noble Lords may recall that the King’s programme leader, Dr Oliver Johnson, was previously policy director for the All-Party Parliamentary Group on Global Health, a number of whose members are in the House at the moment.

The King’s team had to work with what was available at the start of the epidemic. Its members created an isolation facility out of the rooms and equipment that they had to hand. As a result, they have developed an approach that engages local people alongside international workers and can be scaled up both quickly and cheaply. They have had 600 people through their unit, of whom 300 have tested positive—that is one-quarter of all those infected in Freetown. There have, however, been no infections of local or international staff in the unit.

Such a scale-up would involve creating small local units for treating people with the minimum of facilities and staff. King’s argues that, while the large, well equipped facilities such as the Kerry Town unit are very welcome, in the short run at least there is also a need for the immediate construction of small facilities that can be operational very quickly and reach into smaller communities. They also have the advantage of maintaining greater local control, rather than just being about international aid. What is Her Majesty’s Government’s view on this? Will they support the further development of these sorts of facilities? Moreover, I have learnt today that seconded NHS staff are going to be allowed to work only in the big units. Is that the case? Will they be allowed to work in these smaller units as well?

I add my praise to the praise that others have already given to the work of so many UK and other volunteers who have shown remarkable courage, as well as skill, in doing the wonderful work that they are doing.

My Lords, I echo the comments of the noble Lord, Lord Crisp. The heroism of those who have volunteered from the NHS, and from all over the world, as health medics to work against Ebola is unbelievably impressive and should raise our sense of the possibilities of a human response of the kind that is needed for the desperate position laid out by the noble Baroness, Lady Kinnock.

I shall be quick. The first point is that the WHO has now named 15 countries that are on the edge of being likely to slip into Ebola epidemics unless there is preventive action as soon as possible. Those 15 countries are all in Africa, mostly in west Africa. There is also, although we have not mentioned this so far, an instance of an outbreak of Ebola separate from the west African outbreak in, of all countries, the Democratic Republic of Congo. Already, 88 deaths have been attributed to Ebola in that country and are not related to the west Africa epidemic, which is rather frightening—it means that we are now looking at the spotty emergence of the Ebola epidemic.

I want to make a rather larger point. I declare an interest as a member of the board of the Nuclear Threat Initiative in Washington, DC, which is currently supporting the one and only global surveillance of infectious diseases, in a unique international network. It is called CORDS and is doing some remarkable work. This last point is the most important one. In a Question to the Government last week, I raised the issue of whether any thought has been given to calling a special meeting of NATO. I mention NATO following a long conversation that I had with the chief assistant adviser to President Obama, Mr Weber of the Department of Defence, now at the Department of State. He made it clear that he thought the NATO countries should call upon NATO to hold a special summit meeting to consider what help it could give, because it is one of the very few organisations in the West that has the capacity for an immediate response in engineering, construction and medical terms.

I want to make it very clear that, as the noble Lord, Lord Crisp, said, we need the rapid engineering to put up field hospitals and immediate centres to deal with the epidemics in rural areas, where—as in, for example, Sierra Leone—the infection rate is now nine times what it was two weeks ago, according to reports from the WHO. We should seriously consider this possibility, recognising the scale and, even more, the immediacy of the crisis, given the 15 countries that are now seriously at risk.

My Lords, I join other noble Lords in praising our volunteers who are currently working in west Africa, and also our Armed Forces who so rapidly constructed the first hospital in Sierra Leone. I congratulate our Government on their rapid response once it became obvious that this Ebola infection was out of control.

There is a lesson here. Infections will continue to come—that is the history of developing viruses in that area. Humans have been infected by four strains of Ebola virus so far, and there remains only one strain that has not yet infected humans but has already been found in pigs in the Philippines. If it goes from pigs to humans, it might become even worse. Marburg virus is just waiting on the sidelines.

What can we learn from that? To control infections we need good health systems and that has been the major failure. The current health systems in west Africa are not adequate and for all the investment we made in AIDS, we have not hitherto helped build good health systems. To control infection we also need to identify and care for patients. We are now beginning to grasp that by building hospital facilities but for Sierra Leone we will probably need 4,800 beds. Currently they have 236. Secondly, we need treatments such as vaccines or drugs. Vaccines are in development; the first is being trialled in Mali and two more—one developed in Canada and another in the US—will start trials soon, but it will be months before we know whether they are effective. There are drugs in development, and I hope that our Government, through Porton Down laboratories, are supporting trials of some of the drugs that are produced by our small biotech companies. Drugs might not directly kill the virus, but they may stop the chain process of replication, so I hope our Government will support that.

I congratulate the Government on their initial effort. We have not yet begun to control this infection, and yesterday’s news of Sierra Leone having 30 corpses appearing in one small area which was supposed to be free of Ebola proves the point.

My Lords, I, too, congratulate the noble Baroness, Lady Kinnock of Holyhead, on securing this short but important debate. The noble Baroness is of course an expert in the field of international development as I remember from the European Parliament. Your Lordships’ House benefits greatly from the noble Baroness’s knowledge and compassion.

I declare an interest as a shareholder and former director of African Minerals, the largest employer in Sierra Leone and the largest contributor to the country’s GDP and budget. I am proud of the work that the company does in supporting medical facilities, schools and orphanages under the leadership of chairman Frank Timis. On a couple of trips to Sierra Leone I was greatly taken with the warmth, resilience and fortitude of the Sierra Leonean people who have been through so much in the bloody civil war. I had the privilege of meeting President Ernest Bai Koroma who is working hard to develop his country. Although the international response to the Ebola crisis was initially tardy, as the noble Baroness, Lady Kinnock, said, I would also like to praise Her Majesty’s Government and our ever excellent Armed Forces in their recent major initiatives. As already mentioned the facilities at Kerry Town and elsewhere will make a major difference.

After Ebola, there will be a need to rebuild the economies of west Africa which are all primarily dependent on natural resources. Ivan Glasenberg, Glencore CEO, has warned of the danger of global mining giants deliberately undermining west African mining companies and thus depriving their Governments of vital revenues. One mining executive has said in response that charity begins at home, which in my view is socially irresponsible.

At the end of the day, Sierra Leone and the other countries of west Africa are grateful for charity, but what they really crave is the self-respect which comes from self-sufficiency and we should help them achieve that aim as they struggle to survive this terrible crisis.

My Lords, in her powerful opening speech the noble Baroness, Lady Kinnock, referred to the tragic legacy of the number of orphans who will be left in these west African countries as a result of the Ebola epidemic. Last week I attended an international conference which highlighted the plight of the world’s orphans. The number of orphans worldwide is already estimated to be around 150 million and, compounded by HIV/AIDS, we know that many of those are in Africa. If the WHO’s estimate is correct that more than 1 million people in west Africa will die from Ebola, and that by Christmas there will be 10,000 Ebola orphans, the noble Baroness, Lady Kinnock, is right to have made this a key question in her remarks. I hope that when the Minister comes to reply, she will tell us how we can develop a long-term plan for the care of those orphans.

I would like to ask the Minister a number of other questions, some of which I have raised previously with the Government. How have they responded to the motion on Ebola passed by the BMA last month, especially its call for the provision of more protective clothing and the training of staff? Is she in discussion with the BBC World Service to see how it can sustain and expand its excellent African initiative to disseminate public health information about the disease? Can the Minister also tell us—I have raised this point with her on the Floor of the House before—what response the Prime Minister received from the 27 European leaders to whom he wrote asking them to step up their donations after it was revealed that the Swedish furniture manufacturer, IKEA, had given a bigger donation than the Governments of Spain, Norway and Luxembourg combined? Can she say whether the first part of the 700-bed facility which we are constructing in Sierra Leone opened on schedule at the end of last month; and when the rest of the facility will be functional? Are they keeping under review the use of merchantmen and cruise ships as potential hospital ships capable of providing immediate beds and isolation? Is she truly satisfied that British personnel can be cared for adequately in west Africa rather than being flown home, should they contract the virus? Given its successful use in the case of the British nurse flown home after being infected with Ebola, are there sufficient supplies of ZMAP available to immediately treat others, or are those supplies exhausted?

Among all the things that can be said about Ebola, it represents a major setback to development. I hope the Government will reconsider their opposition to putting universal healthcare at the heart of global development, for without such provision the festering conditions in places such as Monrovia and Freetown are a perfect breeding ground for the further spread of epidemics of this kind.

My Lords, I, too, thank my noble friend for initiating this vitally important debate, and like her I welcome the Government’s response on the ground and their decision to provide more than £200 million for trials developing new treatments and vaccines for Ebola, working alongside a range of partners from both the public and private sector.

This crisis underscores the importance of investing in a strong system of research and development for global health. As the noble Lord, Lord Patel, said, the fundamental lesson is that we do not know what else is around the corner in terms of other viruses and infections. It is also possible that efforts to control the Ebola virus in those countries affected by the outbreak risk setting us back on the gains made against malaria as health systems have been pushed to breaking point and people avoid using them because they fear contracting Ebola. In 2012, malaria killed 7,000 people in these countries. As we have heard, most of them were children. What steps are being taken to ensure that we are offering other health services alongside containing and eliminating the Ebola virus in west Africa?

The long-term impacts for these countries will be catastrophic. What are we doing to ensure that other local services such as education and local markets are not severely impacted? My party has called for universal health coverage and access to be placed at the centre of global development. The noble Baroness, in response to an earlier question of mine, said the United Kingdom supports the development of health systems in developing countries, but as we have heard, the United Kingdom—the home of the National Health Service—is still opposing making universal healthcare and access an explicit goal at the UN. Can the Minister explain why?

My Lords, I, too, would like to thank the noble Baroness, Lady Kinnock, for securing this debate and for so ably and movingly introducing it. On behalf of DfID, I thank noble Lords for their tributes to the department in this crisis. As I said the other day, if anything shows the importance of aid, both morally and for our self-interest, it is this epidemic. We are all globally linked and noble Lords made that point extremely clearly. I assure the noble Lord, Lord Giddens, and the noble Baroness, Lady Kinnock, that we will be examining the lessons from this crisis. Because of that global linkage, it becomes extremely important that we draw out what we can learn from this.

My noble friend Lord Ridley and other noble Lords are right that the root of this—the cause of the spread of this epidemic—is poverty. Of course, we will need to work internationally to improve and strengthen our international organisations. However, as my noble friend Lord Chidgey says, we need other countries to respond as well, not only to this crisis but to that analysis, and to take forward the ability to respond internationally.

The noble Lord, Lord Giddens, is also right that we need to make huge efforts to contain this in case we should see, as we do not yet see, a levelling off of numbers; obviously, we hope that with the measures we put in place we may be able to detect that. However, if and when we see that, we should not lessen our efforts, otherwise the epidemic will spiral further. He and other noble Lords are right about the economic effect of Ebola. As regards Sierra Leone, the IMF estimates that its GDP growth is likely to be about 6% rather than the 11.3% it had estimated before this crisis. As other noble Lords—the noble Baroness, Lady Kinnock, my noble friend Lord Fowler and others—have emphasised, the health systems we are facing here reflect the fragility of these states, which is why the epidemic has been able to take root.

We are certainly very fortunate in the United Kingdom to have the outstanding staff in DfID who are working both here in the UK and in Sierra Leone. I pay tribute to them as well as to the staff in the Ministry of Defence, the FCO, the Department of Health, from across the NHS and from NGOs who have volunteered their services in one of the most dangerous situations in the world. The audio diary that we hear on the “Today” programme should bring it home to everyone how important, but also how incredibly challenging, their work is. The noble Baroness, Lady Armstrong, spoke of health workers, and the numbers are extraordinary. Some 852 NHS front-line staff and 130 staff via Public Health England have volunteered, which is clearly outstanding.

The Ebola epidemic in west Africa continues to grow. The latest figures from the WHO as of 31 October put total cases in the region at 13,567, with 4,951 deaths. We know that that number is an underrecording. The UK has now committed a total of £230 million to the response in Sierra Leone. As noble Lords know, we are focusing on that country while the United States focuses on Liberia and France on Guinea. That sum includes the commitment to aid-match the first £5 million of the appeal launched by the Disasters Emergency Committee. I, too, pay tribute to the DEC and to the public response to its appeal. We are now the second largest bilateral contributor in this epidemic. We have committed, among other things, to provide over 700 beds. I can assure the noble Lord, Lord Alton, that the first UK 92-bed treatment hospital opened yesterday in Kerry Town. That facility includes 12 beds that are set aside for health workers who are staffing the beds, which will increase to 20. As I said in a previous answer to the noble Lord, Lord Alton, it may well be best, on a case-by-case basis, to treat a case there in Sierra Leone rather than to expose that person, if very sick, to being transported home. The intention is to be able to provide the same level of care, whether it is here or there.

As the noble Baroness, Lady Hayman, noted, ensuring safe burials is key to turning around the epidemic. With the United Kingdom’s support, International Red Cross burial teams in the western area, which accounts for approximately a third of Sierra Leone’s population, are now burying 100% of reported bodies within 24 hours. That is a huge improvement over the situation just a few weeks ago.

We are also expanding laboratory capacity and have pledged £20 million to establish, equip and run at least three new laboratories. We are also providing isolation within communities through up to 200 community care centres, which are the most effective way to prevent further spread. The noble Lord, Lord Crisp, noted that that model is innovative and unique and he is correct. The purpose is to have safe, humane isolation as the key to reducing community transmission. The faster we can bring down those transmission rates, the sooner the health system can resume functioning. Noble Lords mentioned the challenges with other diseases, maternal care and so on, which are also being undermined by this epidemic.

Some of the CCCs are to be located within primary healthcare facilities, which will allow rapid separation of patients presenting with fever—suspected Ebola cases—from others, which will allow healthcare workers to continue to offer routine services such as antenatal care, routine immunisation and other essential health services. The noble Baroness, Lady Kinnock, in particular, flagged the concerns of pregnant women who are reluctant to come in for care. Of course, the centres also help to protect healthcare workers, which, again, is absolutely vital.

We are also supporting this with social mobilisation work. I too noted the very interesting report from the BBC World Service on what it is doing to encourage behaviour change. All that work is overseen by a command and control centre to co-ordinate the response.

Many noble Lords have mentioned the weakness of the health systems in Sierra Leone and elsewhere. Of course that is, as I said, part of the root of the problem. Clearly our current priority must be to help tackle this epidemic; but obviously, we will then wish to help Sierra Leone to return to the trajectory it was on before the crisis, which was moving from a fragile state after conflict to a middle-income economy. That, of course, will include the strengthening of its health system. I note what my noble friend Lord Fowler has said about health workers, and I know the efforts that have been made by the NHS to try not to draw upon staff from developing countries such as Sierra Leone.

We are engaging with partners to ensure that other countries in the region are prepared. We are ensuring that our bilateral programmes in high-risk countries actively support national emergency preparedness. It is of course encouraging to see that, in the first instance, Nigeria was able to contain the case that arrived in Lagos, and to see the way in which it ensured that although others were affected, the virus did not spread further. However, we are constantly vigilant, because other cases may develop.

The UK is also playing a leading role in galvanising international support—a number of noble Lords mentioned that. We are very glad that, last Friday, the UK signed an MOU with Norway to establish the deployment of up to 200 Norwegian health personnel in Sierra Leone. We also welcome the Government of Australia’s commitment yesterday to manage and run a 100-bed treatment facility in Sierra Leone. The EU has pledged €1 billion towards that, and we will be meeting with all our partners to discuss bringing aid forward.

We are working closely with UN agencies, for example with UNICEF on social mobilisation, child protection and so on. A number of noble Lords—especially the noble Baroness, Lady Kinnock, and the noble Earl, Lord Listowel—emphasised the dire situation of children. We are working very closely with UNICEF to support the needs of vulnerable children, including those who have been orphaned by Ebola. We do not underestimate the challenges that they face.

I am very short of time; I will be very happy to speak to my noble friend afterwards, and I will come on to her point about NATO. NATO is following closely the situation through its crisis management and civil contingency functions, and the allies are assessing whether and how NATO would add value at this stage of the response. However, I also note what my noble friend Lord Chidgey said with regard to what the military might or might not be able to contribute.

The noble Lord, Lord Patel, is right to emphasise the need both for treatments and for vaccines. I hope he will be reassured that we are prioritising both. It is immensely encouraging to see the work of the Lister Institute, for example, and the possibility of a vaccine. Clearly, it could be critical to this epidemic if that work was brought forward, but it will certainly be critical in stemming future epidemics. I note very much what the noble Lord says.

An unprecedented outbreak requires an unprecedented response. That is what we have committed to and we are encouraging the international community and all the international players in each country to play their part to ensure that this terrible epidemic is defeated. As noble Lords have said, poverty is at the root of what we are seeking to address here. That is why we have made the commitment to aid to the poorest countries, as the noble Earl, Lord Listowel, pointed out. That is what it is all about.