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Ebola Outbreak: Democratic Republic of the Congo

Volume 797: debated on Monday 20 May 2019


My Lords, I apologise to the House for the slight delay. With the leave of the House, I shall now repeat a Statement made today by my right honourable friend the Secretary of State for International Development. The Statement is as follows:

“Ebola is back, this time in the eastern Democratic Republic of the Congo. This is the largest outbreak in the country’s history, the second largest outbreak in the world and the first in a conflict zone. So far, 1,209 people have died. We must do much more to get a grip on this situation.

This is not a simple question of virus control. If it were, we could simply repeat what we were able to do—at huge risk and cost—in Sierra Leone and Liberia and even what, to some extent, the DRC Government and the World Health Organization were able to do in Équateur and western DRC over the first six months of last year: go out into village after village, identify all the cases, trace all their contacts and their contacts’ contacts and, through preventing further chains of transmission, contain the outbreak.

However, this is not a situation like that. This is North Kivu, the centre of a conflict dominated by dozens of separate armed groups largely outside government control. Such groups have begun to attack and kill health workers, meaning that key international experts have had to be withdrawn from the epicentre of the virus. The decision not to allow this province to participate in the recent elections, partly on the grounds that it was an Ebola area, has fuelled suspicion that Ebola is a fabrication developed by hostile political forces. As a result, communities are reluctant to come forward when they have symptoms; they are also reluctant to change burial practices or accept the highly effective trial vaccine. The Congolese army and Government, which have successfully contained nine previous Ebola outbreaks over the past 45 years, are struggling to operate in the epicentre of this outbreak; so too are UN peacekeepers and the WHO. Although this area is very dangerous and difficult to access, it is not sparsely populated. The epicentre of the outbreak is Butembo, which has a population of a million people. The surrounding areas contain almost 18 million people.

To be clear, according to all our expert analysis here at the moment, the current disease profile poses only a low to negligible risk to the United Kingdom, so this Statement should not be a cause for panic at home. However, this outbreak is potentially devastating for the region. It could spread easily to neighbouring provinces and even to neighbouring countries.

I want to take a moment to commend all those in both the Congolese Government and the international community who are working in these very difficult situations to bring this disease under control. My predecessor, the right honourable Member for Portsmouth North—she just made her Statement to the House—paid tribute to Dr Richard Valery Mouzoko Kiboung, who was killed in an attack by an armed group on 19 April while working for the WHO in the Ebola response on the front line. I imagine the whole House will join me in expressing our deepest condolences to the family, friends and colleagues of Dr Richard, and to all those who have lost loved ones as a result of this outbreak.

We now need to grip this situation and ensure that this disease is contained. As you can imagine, this has been my key priority in the emergency field since I was appointed to this role just over two weeks ago. I spent the weekend in discussions with Sir Mark Lowcock, the United Nations humanitarian co-ordinator, and the director-general of the WHO, Dr Tedros, who has so far paid eight visits to the affected area. I have also spoken about the response with the Deputy Secretary-General of the United Nations, Amina Mohammed, and was pleased to see that there has been a real step up in the seniority of UN staff on the ground, particularly in places such as Butembo. Both the Health Secretary and the Foreign Secretary have been supporting this agenda in recent meetings over the past four days: the G7 health meeting and the WHO meetings in Geneva. I have also convened a meeting with a number of international experts in the field, including Brigadier Kevin Beaton, who helped lead the UK military response in Sierra Leone and Liberia, and the Chief Medical Officer to the UK Government.

On the basis of their advice, I concluded that we need to not only provide more money immediately to support the front-line response—health workers—but support the vaccination strategy and put more of our expert staff on the ground into the response. This is not just about recruiting doctors; we need people who understand and can work with the DRC Government and the military, even the opposition forces, to create the space for us to work. We need people who know the UN system well so that they can drive and shape the UN response. These people need to be not in London but on the ground because they need to be able to learn and adapt very quickly as the disease spreads. We are already deploying epidemiologists through our public health rapid support teams, in partnership with the Department of Health and Social Care. I am also now considering deploying additional officials with specialities in information management, adaptive management, anthropology and strategic communications.

However, it is important for us all to understand that this is not a problem the international community can solve from a distance. This is a political and security crisis as much as a health crisis; in the end, the response must be driven by local health workers and local leaders. There are some positive signs. DfID has been a key player in developing a new experimental vaccine for Ebola, which is proving highly effective. More than 119,000 doses have been administered so far in eastern DRC—an achievement that has probably saved thousands of lives. Modelling from Yale suggests that the use of the vaccine has reduced the geographic spread of Ebola by nearly 70%. This is not just about statistics; this is about, for example, Danielle, a 42 day-old baby in eastern Congo who survived Ebola last week thanks to the inspiring work of community volunteers, themselves Ebola survivors, and front-line health workers supported by UK aid.

Of course, we cannot do it alone. This needs grip and urgency, but it also needs humility. One reason why I have been talking in detail about this issue to Mark Green—my US opposite number—is not only do we share the US analysis but the Americans will inevitably be major players in this response in terms of finance and expertise, as indeed they were in the Liberia Ebola outbreak. We need many more international donors to match our financial contributions and to sustain the international and local health operations in the field. That is why the UK has just hosted an event specifically on Ebola to build support for the response in the World Health Assembly in Geneva. This is also why I have agreed that my colleague the Minister for Africa should visit eastern DRC immediately.

To conclude, this is a very dangerous situation where the Ebola virus is only one ingredient in a crisis which is fuelled by politics, community suspicion and armed violence. We need to act fast and we need to act generously, but above all we need the right people on the ground who are completely on top of the situation, who are able to come up with quick solutions and can guide us in keeping up support for—and, yes, sometimes the pressure on—the UN system, NGOs, opposition politicians and the Government of DRC to get this done. The stakes are very high and I will keep the House updated on our response”.

My Lords, that concludes the Statement.

My Lords, I thank the Minister for repeating the Statement and I join her in expressing sympathy for all those who have lost loved ones in this latest Ebola outbreak. It is true—the WHO has said as much—that it is likely to spread into neighbouring countries, which is why this response is so urgent. I welcome the Government’s response and the fact that we are drawing on the expertise and knowledge built up as a result of our intervention in Sierra Leone. I too pay tribute to the DfID staff for their work on this.

However, as David Miliband from the IRC has said, this outbreak is getting worse,

“despite a proven vaccine and treatment”.

Of course, as the Statement acknowledges, one of the major barriers to delivering the response is the breakdown of trust in the affected community. We have heard from agencies on the ground that one of the major difficulties is that the actors involved in the Ebola response are the very same people who have played a long-standing role in the ongoing conflict in the region. In terms of our response, the priority must be to address this issue.

Given that, can the Minister tell us more about how we are building trust with the Congolese community in terms of their accepting the response that is needed? One clear lesson from the west Africa outbreak, particularly in Sierra Leone, was the role of community engagement. All too often it is regarded as being a soft and relatively non-technical add-on to medical interventions. However, I was pleased to hear the Secretary of State in the other place talk about engaging with political leaders to dispel the myth that Ebola is somehow fabricated.

However, we are addressing other barriers as well. Certainly, the mobilisation of the community should be centre stage in our response in ensuring that we are able to help members of the community protect themselves, particularly in terms of safe burial practices and so on. Can the Minister say whether we are able to work with NGOs on building that community response? What plans do we have to directly fund the NGOs currently operating in the affected areas so that they can continue their work?

The point about this response, along with the one in west Africa, is that it is set against a backdrop of chronically poor health and nutrition indicators that further impact negatively on the affected communities. Can the Minister tell us what steps DfID is taking to support the Congolese Government beyond the emergency response? How are we scaling up the nutrition programmes and how will we be able to strengthen the healthcare systems in such a difficult environment?

I hope that the Minister can update us on all of the programmes because while we may be able to halt the spread of Ebola, there is no doubt that if we do not address the fundamental issues of healthcare systems, this issue will keep coming back to haunt us.

My Lords, I too thank the Minister for repeating the Statement—a slightly different one from that which is available in the Printed Paper Office. I also thank those who have already responded in person to this incredibly dangerous situation. I cite in particular the ground-breaking work carried out by teams led by the former DfID chief scientific adviser, Chris Whitty, who is also at the London School of Hygiene & Tropical Medicine. Those teams have played an extraordinary part in turning around the epidemic in west Africa.

This situation is indeed extremely worrying. It was difficult and dangerous enough when we were engaged in Sierra Leone during that Ebola outbreak, but this is even more difficult because Ebola has struck in an area of conflict where suspicions are aroused by those who are seeking to help, thus undermining what they are able to do. The WHO has identified the main drivers in the continued rise in the number of cases as stemming from insecurity, poor community acceptance, delayed detection and late presentation. Does the noble Baroness agree that this means that cases staying in the community pose huge risks to members of the community as well as to those who seek to treat them?

The noble Lord, Lord Collins, is right about engaging the community. I note the use of the word “anthropology” in the second, rewritten Statement. That understanding in the west Africa cases led to a very different approach to how you engaged with the community.

Then there is the lack of funding. With inadequate funds coming to tackle the crises in Yemen, Syria and elsewhere, how will we make sure that adequate funds come through to tackle this crisis? Does the Minister note that the International Federation of Red Cross and Red Crescent Societies warns that it has enough funding to continue the safe burials required for only another two weeks, amid a $16 million shortfall and increasing infections? Is it receiving UK funding, and will this increase?

The Statement speaks of needing people “on the ground”. Many extraordinarily brave doctors and nurses from the UK volunteered to assist in Sierra Leone, making a decisive difference. Some, like nurse Pauline Cafferkey, almost paid with their lives. Those who went out were screened and trained, largely by UK-Med at the University of Manchester. Is that happening this time? Valiant efforts were made—for example, at the Royal Free—to support any staff, like Pauline, who succumbed to the disease. What support is being given to Sir Michael Jacobs and his team at the Royal Free if more cases present among British staff or the public?

The Ebola outbreak in west Africa gave a huge and welcome impetus to vaccine development. Could the Minister update us on where we are with this? Is the vaccine to which she referred the one developed at the Jenner Institute at Oxford University and supported by DfID?

UNICEF rightly flags the situation of children affected by the disease, either directly or indirectly when they lose a parent. We are much more aware now about the risks to children who lose their parents. How is this being tackled?

I note the changes between the first and second versions of this Statement, especially on what the UN, WHO and US are doing, with possible input also from the London School of Hygiene. It is exceptionally important that we work with all international and national bodies, as we did in a quite remarkable way in west Africa. In even more difficult circumstances, we need that again. I look forward to hearing the Minister’s response.

My Lords, I first thank the noble Lord and the noble Baroness for their sensitive remarks and their clear understanding of the complexities of this very difficult situation with the outbreak in this area of the Democratic Republic of the Congo. I will try to deal with the points raised.

The noble Lord, Lord Collins, rightly said that community engagement is important, and I absolutely agree. He also asked about healthcare programmes and what progress we are making in that respect. On the whole issue of community engagement and trying to understand better what the challenges are, I understand that my right honourable friend the Secretary of State plans to visit North Kivu shortly to understand the situation on the ground and to consider how the UK can continue to support the response.

I assure both the noble Lord and the noble Baroness that the current Ebola outbreak in the DRC is an immediate priority for the Department for International Development. We have dedicated teams leading a co-ordinated UK HM Government response effort. As I indicated in the repeat of the Statement, the UK is one of the leading donors to the response in the DRC and the leading donor in preparedness efforts in the region.

The noble Baroness, Lady Northover, pointed out the huge risk not just to communities but to those endeavouring to help deal with the outbreak. She rightly said that how one engages with communities is very important, and I totally agree. As I have indicated to the noble Lord, Lord Collins, the Secretary of State proposes a visit, and I think that will be extremely helpful.

I may have misled noble Lords in referring to my right honourable friend the Secretary of State; it might be the Minister for Africa who is making the visit. I am reading from a variety of papers here. As the noble Baroness, Lady Northover, indicated, even trying to update the Statement to the version actually delivered in the other place was challenging. It is in fact the Minister for Africa who proposes to visit.

The noble Baroness, Lady Northover, raised the vaccine. The Merck vaccine is being deployed under experimental protocol using ring vaccination. This vaccine has been shown to be highly effective in a trial in Guinea. The Statement indicated that modelling by Yale suggests that the vaccine has reduced the scale of the outbreak by 70%. The noble Baroness asked me something specific about the background to the vaccination; I do not have an answer, but I will undertake to try to obtain more information about that. I understand that there are plans to trial another experimental vaccine outside the current outbreak area, including in key locations such as Goma.

I was also asked about what exactly the UK is doing in terms of experts. We have a UK public health rapid support team, and technical experts including senior epidemiologists, data scientists and a clinical trial specialist have been deployed to eastern DRC. The PHRS team—the rapid support team—has played a major role in supporting preparations for clinical trials of new therapeutic drugs currently being administered to patients.

I think I have managed to answer the main points raised. If I have missed anything out, I shall certainly write to the noble Baroness and the noble Lord.

My Lords, Sir Peter Piot, the Belgian microbiologist who with others more or less discovered Ebola in 1976 and went on to help discover the AIDS virus, told me the other day—I think it is worth passing this on, because he agrees very much with the Statement but went slightly further—that he agreed completely that the problem in this case was the inability to isolate, because of the conflict that the Minister quite rightly mentioned. On this spreading further afield, if not necessarily here, he said he felt that this could be a potential catastrophe. He said we have to remember with microbiology and viruses that, with the speed of air travel, we might well be far more at risk than we realise. That was one of the problems with the AIDS epidemic. I simply pass that on, for he is the expert, not me.

I thank the noble Lord for raising that very important point. There is of course concern about not just the virulence of this disease but the facility with which it can spread. There is always a question to be raised over both spread within the country itself and international spread. I should make it clear that, as I understand it, although no cases have spread beyond the North Kivu and Ituri provinces, the WHO assesses the risk for the regional spread of Ebola as very high, especially given the instability and violence. The UK is the largest donor to preparedness activities, through the WHO regional plan and bilaterally, but it is critical that other international partners step up. DfID staff are working with the WHO, the OCHA, host Governments and other partners to implement measures to robustly prepare for potential spread. The noble Lord makes an important point, and it is an issue that will, I think, be assessed very carefully on a regular basis.

My Lords, as mentioned, this is a serious and dangerous situation. It is dangerous because the number of cases has risen over the past six months, which shows our inability to control or contain the spread of this disease. Of the 1,600 cases reported, 1,100 people have died. Currently, 15 to 20 new cases are occurring every day. We know how to control the spread of this virus and we have learned from the previous outbreak. What we cannot do this time is get health workers in to provide the necessary strategy required to contain the spread of the virus and provide vaccinations. That cannot happen until the warring factions—and there are several of them—stop fighting. We should be working on international arrangements to control the fighting and create a ceasefire: unless we have a ceasefire, we will not be able to contain the spread of this disease. Does the Minister agree?

My second question is this: what is the stock of the vaccinations available? Are we going to run out of vaccines?

If I may, I will respond to the latter point first. I understand that there is availability of vaccines; as to what the stock is, I do not have an answer, but I will endeavour to find out and will respond to the noble Lord.

The noble Lord makes a very important point in relation to the particular elements of this disaster—and it is a disaster—which make addressing it so challenging and difficult. It is correct that there is a need to address community conflict and issues of suspicion, distrust and violence, and activity by hostile and disparate groups, which is, as he rightly identifies, prejudicing the ability to deal with the disease itself.

We also have to recognise that there are delicate cultural and national issues within the Democratic Republic of the Congo. That is why, echoing the points made by the noble Lord, Lord Collins, and the noble Baroness, Lady Northover, I think it is very important that, in conjunction with the Government of the Democratic Republic of the Congo, we consider how best we can help them deal with these issues. We want to be very careful that there is no question of trying to impose solutions or be seen to be interfering when such is not our intention.

The noble Lord makes an important point, and it is something of which the UK Government are acutely aware. That is one reason there is a desire for the forthcoming ministerial visit to North Kivu. Following that visit, it will be possible to make a further assessment as to what we can do—either ourselves, bilaterally with the DRC, or in conjunction with our global partners in the World Health Organization and the United Nations—to more constructively address the important issue he has identified.

My Lords, I thank the noble Baroness for repeating the Statement from the other place. My diocese is linked directly with the Congo and I have had a relationship with the current bishop of North Kivu, Bishop Isesomo, for nearly 20 years.

I see the outbreak of Ebola as the presenting issue for what is a community breakdown. Over the past 25 years, particularly since the 1990s, we have seen a form of alternative governance which makes it very hard for any kind of intervention to work that does not tackle the question of security. One of the major differences between what is currently seen in the eastern side of the Congo and Sierra Leone is that we could guarantee security more clearly in Sierra Leone than we can in the Congo. I welcome the noble Baroness’s comments on the need for sensitivity as we work with the Government of the Congo, but I urge that we take security as a top priority. Dr Richard Mouzoko was killed by people practising the alternative governance that we currently see. Any form of intervention that does not provide security for health workers, and for other aid workers who are prepared to risk their lives to be part of any intervention, would simply leave us very vulnerable and unable to tackle the root causes of the problem, which are fundamentally to do with how the communities relate to each other.

I thank the right reverend Prelate for his remarks. The whole Chamber will recognise that he speaks with deep personal knowledge, and I am sure a degree of personal pain, in understanding what is happening in that country. Sadly, it is the case that community trust is one of the most challenging aspects. When we consider that there have been ongoing attacks on both Ebola treatment centres and front-line health staff, it paints a very depressing picture indeed.

As I said, working in conjunction with the Government of the Democratic Republic of the Congo and other global and NGO partners, we are endeavouring to address the very issues the right reverend Prelate talks about. My right honourable friend the Secretary of State for DfID made it clear in the other place that he is actively engaged in such dialogue to determine how pressure can best be brought to bear. He was very clear that pressure might have to be brought to bear on the Government and opposition parties, United Nations agencies, NGOs—whoever. Certainly, the UK Government are prepared to pursue that energetic role if that would make the attainment of treatment more realistic for the very people now needing it and surmount the challenges that the noble Lord, Lord Patel, rightly identified as being the impediment to getting treatment to those people.

My Lords, as the noble Lord, Lord Patel, said, we have the technical ability to tackle Ebola. We know that. This outbreak in the DRC faces an incredibly complex challenge of insecurity, which I do not intend to go into in much detail, but it also faces an underfunding challenge. I thank the Minister for repeating the Statement, which was comprehensive and very informative, and speaks well for the Government. The insecurity challenge is enormously difficult—war has been raging in the DRC for a long period—but the underfunding challenge is simple. The Red Cross says that it needs $30 million to carry out all of its activities in the DRC and to prepare the surrounding countries for the likelihood of spread. It has half of that. The international community has behaved disgracefully. It promised much more than it has delivered. The Government should concentrate on putting pressure on our international allies, friends and others to come up with the money that they said they would donate for this crisis.

I thank the noble Lord. I am sure that the point he makes will resonate not just in this Chamber but beyond. He is right: funding remains a concern. The World Health Organization continues to report gaps in funding of critical activities. The UK has been one of the major donors alongside the USA, the World Bank, ECHO and Gavi, and continues to lobby other donors to contribute, but the noble Lord is right to identify an area of profound concern. Certainly, this Government will be untiring in our efforts to persuade other parties that they need to step up to the plate.

My Lords, the noble Baroness, Lady Northover, asked about training being provided to anyone who might be going out there to work in any facility. I would be grateful if the Minister could answer that question. This is clearly an incredibly difficult situation. As part of that training, what consideration is being given to the security of anyone at all who is going out there? Also, what is being done internationally about the movement of people in and out of these areas, particularly on air travel, whereby people may travel great distances? Have we reinstated screening at our own borders and points of entry for air travel from affected parts of Africa? Are staff travelling to work in those areas being offered entry on to the Merck vaccine trial to avail themselves of the vaccine if they so wish?

The noble Baroness raises a number of points. I do not have detailed information about the training, so I shall look into that and undertake to write to her. On risk, at present, Public Health England’s assessment is that the threat of Ebola to the UK remains negligible—very low. It monitors the situation daily and updates the risk assessment every two weeks. That will be kept under review depending on what happens. The noble Baroness may be aware that there are no direct flights between the area and the UK. The Government will anticipate and review any intensification of the level of risk very carefully with Public Health England. It will be a combination of making a judgment depending on what is happening and what evidence there is for passenger transport coming from affected areas to this country.

The wider issue of risk to surrounding areas is all about the preparedness strategy. There is concern about that. Clearly, surrounding countries are at risk. That is being taken very seriously and is being regularly reviewed.

I want to ask my noble friend about the relationships with the surrounding countries, which she nearly touched on just now. The Central African Republic is to the north of this area and Uganda is to the east. Uganda has considerable experience of having dealt successfully with Ebola outbreaks, but our missions, working with those countries, must also make people aware of the transmission dangers from Kivu. Many combatants there have come from outside North Kivu. Therefore, it is necessary to deal not just with what is happening in North Kivu and with the Government in Kinshasa, which is a very long way away, but with the Central African Republic and to take the help of the Ugandans, who have experience of dealing successfully with outbreaks of Ebola .

I thank my noble friend, who raised a number of important issues. As she rightly identified, in Uganda the Government have already vaccinated more than 4,400 health workers in high-priority districts and are rapidly responding in testing alerts of potential cases. I have a little information about Rwanda. Through funding to UNICEF and the WHO, the UK is backing the Government’s preparedness plans, including the training of healthcare workers—that will be of interest to the noble Baroness—vaccination planning and the screening of people passing through Rwanda’s borders. In South Sudan, another neighbouring country, 1,150 health workers have been vaccinated and UK support has led to the installation of an Ebola screening facility at Juba International Airport. In Burundi, we have deployed a humanitarian expert to support preparedness and co-ordinate UK effort and support. We are also strengthening the WHO’s capacity for effective co-ordination, supervision, monitoring and evaluation of Burundi’s preparedness efforts to prevent, detect, investigate and respond to EVD.

My Lords, is it known how the epidemic started? Is bushmeat still being eaten by the locals? Prevention is vital. Are the schools closed in the infected area? That would help.

I raised the noble Baroness’s first question with my officials before I entered the Chamber. I was interested to know the genesis of the spread of the disease. I understand that the likely source is indeed eating contaminated meat. The Chamber will understand that that is very difficult to control in such an area. I have no specific information on schools in the area, but I shall find out.

Going back to funding, I wonder whether the example of Sierra Leone will help. At the time of the previous epidemic, which killed 4,000 people in Sierra Leone, the Sierra Leone Government appealed for funding from a wide range of sources. One of them was the IMF, which lent huge sums of money that had to be repaid. I see the noble Lord, Lord Bates, is in his place. He straddled the Treasury and the Department for International Development. Will the Minister pass on the question of whether the same thing will occur in the DRC? Although those departments are not close to the problem, they will certainly get involved and will be appealing for assistance. Loans that cannot be repaid are not a help.

I thank the noble Earl for raising a very important and interesting point on which I do not have information, but I will speak to my noble friend Lord Bates and make further inquiries of the department about the situation.