UK’s response to the Ebola outbreak in West Africa
11 Feb 2015 03:33 PM
The initial response of the international community to the Ebola outbreak in West Africa was totally inadequate according to the Public Accounts Committee's report published on Wednesday 11 February 2015.
Chair's comments
The Rt Hon Margaret Hodge MP, Chair of the Committee of Public Accounts, and Stephen Phillips QC MP yesterday said:
“The current Ebola outbreak in West Africa is the largest known outbreak to date, with over 17,000 cases and 6,000 deaths reported up to the end of November 2014. The UK Government has committed a £230 million package of direct support to help contain, control and treat the Ebola outbreak in West Africa, and total funding could rise to some £330 million.
We wholeheartedly support the UK’s efforts to combat the outbreak and commend the bravery of all those working on the ground, including those from the Armed Forces and the many volunteers who have travelled to the region to help.
However, the initial response of the international community to the Ebola outbreak in West Africa was totally inadequate. Although there was evidence that the outbreak was not pursuing the course of previous outbreaks as early as April 2014, the World Health Organisation did not declare the outbreak as a public health emergency of international concern until early August 2014. At that stage, over 1,000 cases of Ebola had been confirmed, including over 900 deaths.
We were told by DFID’s Chief Scientific Advisor, “… there is no doubt that multiple bits of the system messed up over this, not in the first couple of months, when, in a sense, it was very early in the epidemic, but in that period up to about July.
The Department was far too slow to react to the developing situation, missing an opportunity to contain quickly the outbreak of Ebola in at least Sierra Leone. The Department relied on the view of the World Health Organisation and paid insufficient attention to the views of NGOs on the ground that a massive deployment of resources and healthcare workers was needed to fight the outbreak. Had the Department acted sooner, both lives and money would have been saved.
A capability gap currently exists in building and running specialist facilities necessary to deal with outbreaks such as Ebola. This meant that scaling up the operational capacity of the UK response was slower than it might have been. The Department told us this had been due predominantly to the absence of organisations that had both the capabilities and willingness to deliver the Department’s interventions.
The lack of health infrastructure in Sierra Leone also hampered the response to the Ebola outbreak, and has probably led to an increase in fatalities as a result of other health problems as the system was overwhelmed. At the outset of the outbreak, there were only 120 doctors in the entire country and only one virologist, who sadly lost his life at an early stage.
Future efforts must be directed to bolstering health care systems in the region and to supporting governments to ensure that these are sufficiently robust to deal with the emergence of public health emergencies.
There is no scientific justification for the UK Government’s decision to prevent direct flights to the affected region from the UK, something which has likely increased the cost and difficulty of dealing with the outbreak. These should be restored as soon as possible.
Once the outbreak has been contained, the Department needs to review whether its current preparedness and protocols when faced with a potential international medical emergency are adequate for effective prevention and response.”
Margaret Hodge and Stephen Phillips were speaking as the Committee published its 39th Report of this Session which – on the basis of evidence from Mark Lowcock CB, Permanent Secretary, Department for International Development, Professor Chris Whitty, Chief Scientific Adviser and Director of Research and Evidence, DFID, Fergus Drake, Director of Global Programmes, Save the Children and Sanjayan Srikanthan, Emergency Field Director, International Rescue Committee – examined the UK’s response to the outbreak of Ebola Virus Disease in West Africa.
The Department for International Development (the Department) is coordinating the UK’s response to the outbreak of Ebola Virus Disease (Ebola) in West Africa. We wholeheartedly support the UK’s efforts to combat the outbreak and commend the bravery of all those working on the ground, including those from the Armed Forces and the many volunteers who have travelled to the region to help. The international community was very slow to recognise the seriousness of the outbreak of Ebola in West Africa and the Department failed to respond with sufficient urgency to an emerging crisis which could have been contained had action been taken sooner.
There are promising signs that the Department’s interventions are having a tangible impact, although there remains uncertainty over the future trajectory of the outbreak. Once the outbreak has been contained, the Department needs to review whether its current preparedness and protocols when faced with a potential international medical emergency are adequate for effective prevention and response. Future efforts must be directed to bolstering health care systems in the region and to supporting governments to ensure that these are sufficiently robust to deal with the emergence of public health emergencies without their being overwhelmed. There is no scientific justification for the UK Government’s decision to prevent direct flights to the affected region from the UK, something which has likely increased the cost and difficulty of dealing with the outbreak. These should be restored as soon as possible.
The UK government has committed a package of direct support of at least £230 million to help contain, control and treat Ebola in West Africa. The Department is distributing this money to other departments such as the Ministry of Defence, international institutions and non-governmental organisations. The UK package focuses predominantly on Sierra Leone, and includes support for the construction of treatment facilities, the provision of over 700 treatment beds, and the training and management of burial teams. The first UK-constructed treatment centre opened in November 2014 in Kerry Town, Sierra Leone, and is managed by Save the Children under contract with the Department.
The World Health Organisation’s role is to provide leadership within the international community on matters critical to health and to engage in partnerships where joint action is needed. The international response to the Ebola outbreak also includes other United Nations agencies, international finance institutions, NGOs and bilateral donors. At country level, the governments of the USA, the UK and France are leading this response in Liberia, Sierra Leone and Guinea respectively.
Conclusions and Recommendations
The initial response of the international community to the Ebola outbreak in West Africa was totally inadequate. Although there was evidence that the Ebola outbreak in West Africa was not pursuing the course of previous outbreaks as early as April 2014, the World Health Organisation did not declare the outbreak as a public health emergency of international concern until early August 2014. At that stage, over 1,000 cases of Ebola had been confirmed, including over 900 deaths. The outbreak had by then spread from Guinea, where it had first been recognised in December 2013, to at least 3 other countries in West Africa (Liberia, Nigeria and Sierra Leone).
The World Health Organisation has rightly been criticised for failing to act adequately to prevent the spread of the disease between December 2013 and the end of July 2014. Had the World Health Organisation acted sooner, it is likely that the outbreak could have been curtailed sooner. The Department was in a position as a major donor to many of the international institutions with a role in containing the outbreak—and the World Health Organisation in particular—to ensure that the international community responded more promptly. As we were told by the Department’s Chief Scientific Advisor (Professor Whitty), “… there is no doubt that multiple bits of the system messed up over this, not in the first couple of months, when, in a sense, it was very early in the epidemic, but in that period up to about July”. The Department could and should have listened to and responded to the views of Médicins Sans Frontières and others on the ground who were warning of the seriousness of the outbreak rather than relying on it simply to follow the trajectory of previous outbreaks, which there was every indication it would not do.
Recommendation: The Department should take a lead role in the international community’s efforts to learn lessons from this Ebola outbreak. It should also seek assurances that World Health Organisation staff in all of its regions are sufficiently capable to identify and respond to future emerging public health emergencies.
The Department was far too slow to react to the developing situation, missing an opportunity to contain quickly the outbreak of Ebola in at least Sierra Leone. The Department confirmed that it had been aware of a confirmed Ebola outbreak in Sierra Leone in May 2014. In the early stages of the outbreak, the international community had different views on how best to react. The Department relied on the view of the World Health Organisation and paid insufficient attention to the views of NGOs on the ground that a massive deployment of resources and healthcare workers was needed to fight the outbreak. There was also an unfortunate time lag between the Department’s recognition that it had to act and its allocation of funding to deal with the outbreak. In early August 2014, it had announced £5 million of support; by September, this had risen to £100 million and by the time of our hearing, it had reached £230 million. Had the Department acted sooner, both lives and money would have been saved. As the Permanent Secretary of the Department (Mr Lowcock) said to us, “I agree with you 100%: had the world, the Government of Sierra Leone, WHO, we and others acted earlier, it would have been cheaper and easier to solve the problem.”
Recommendation: The Department should make sure it has procedures and protocols in place which allow a timely and pre-emptive response to developing public health emergencies in countries which receive UK Aid.
The Department lacked the experience and capability fully to respond to the outbreak. The delay in setting up the UK’s response to the outbreak was, in part, due to the absence of organisations that were capable and willing to deliver the Department’s planned interventions, such as building and operating Ebola treatment facilities. We recognise that the circumstances of an Ebola outbreak necessitate an incremental scaling up of operational capacity to create safe environments for the health workers on the ground. However, the lack of experience of dealing with medical emergencies—and Ebola in particular—and the lack of capacity in the Department and its partner Save the Children, meant that scaling up the operational capacity of the UK response was slower than it might have been.
Recommendation: A capability gap currently exists in building and running specialist facilities necessary to deal with outbreaks such as this. The Department should create and maintain a detailed contingency plan for sudden onset medical emergencies to ensure that it can quickly deploy its own and partners’ staff and equipment through a structured intervention process.
The lack of health infrastructure in Sierra Leone inhibited a quicker response to the crisis. The health infrastructure of Sierra Leone has improved since the end of the civil war, but remains weak and vulnerable to unexpected pressures. Corruption remains a major concern. In Nigeria, where a more developed medical services infrastructure exists in at least part of the country, local health professionals were able to respond more quickly to the emergence of Ebola and were therefore able to contain the disease and prevent its getting out of control. Looking to the future, the Department correctly agrees with us that it needs to seek to strengthen Sierra Leone’s health system as a priority through the UK’s bilateral aid programme. At the outset of the outbreak, there were only 120 doctors in the entire country and only one virologist, who sadly lost his life at an early stage. The lack of health infrastructure not only hampered the response to the Ebola outbreak, but has probably led to an increase in fatalities as a result of other health problems as the system was overwhelmed.
Recommendation: The Department should prioritise investment in local health infrastructure of developing countries in receipt of UK Aid so that there is a better capability to respond quickly to emerging public health emergencies. It should also ensure it is doing all it can to support the ability of developing countries to prevent similar disasters in the future.
Political decisions with no basis in scientific fact hampered the response of the international community, NGOs and the Department to the growing crisis and led to increased cost in dealing with the outbreak. Ebola is a very serious disease and a matter of legitimate fear and concern to the public. Political reaction to scaremongering on the part of sectors of the media was predictable, but inevitably caused difficulties for the international response, in particular in the revocation of licences to carriers flying direct to the region.
The revocation of licences to carriers to fly direct to the region was a political decision with no basis in science and was inconsistent with World Health Organisation advice. As we were told by one witness (Professor Whitty), “I do not think that [the decision to cancel direct flights] was a decision driven purely by science …It was a political decision.” The Department accepts that this decision has caused inconvenience. In our judgment, it will inevitably have led to an increase in the costs of dealing with the outbreak and, potentially, to further loss of life.
Recommendation: There is no scientific justification for the UK Government’s decision to prevent direct flights to the affected region from the UK, which has likely increased the cost of dealing with the outbreak. Licences to fly to West Africa should be restored as soon as possible.
There are clear lessons to learn from the Department’s response to the Ebola outbreak. We recognise that the Department faced a steep learning curve in implementing its response to the Ebola outbreak. The Department should capitalise on the knowledge and expertise it has developed to help prevent, or respond to if necessary, similar outbreaks, such as Marburg virus disease. The Department outlined a number of initial lessons from the Ebola outbreak that it intends to follow up. These included developing early warning surveillance and improving epidemiological intelligence. By taking the necessary steps to learn lessons, the Department can help to build confidence in the UK’s response to and expenditure on public health emergencies overseas. We were told by the Permanent Secretary (Mr Lowcock) that the Secretary of State has indicated that Parliament should be involved in this process. We agree.
Recommendation: Once the Ebola outbreak is brought under control, the Department should undertake and publish a rigorous evaluation of all aspects of the UK’s response to the crisis. The evaluation should make practical recommendations as to the steps the Department, other government bodies, the international community and non governmental organisations should take to prepare for future crises of this type.
Further information