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Select committee inquiry

Ebola: Responses to a public health emergency

Closed

International Development Committee · Opened 13 July 2015 · Closed 19 January 2016

2 recommendations · 19 conclusions
Inquiry on parliament.uk ↗

What the inquiry looked at

“The International Development Committee urges the Government to lead efforts to reform the World Health Organization.”

The committee's words, from the inquiry page on parliament.uk ↗.

What it found

In the committee's words, from the summary of 2nd Report - Ebola: Responses to a public health emergency ↗

The deadliest outbreak of Ebola virus disease in history, and the first to hit epidemic levels, struck the West African countries of Guinea, Liberia and Sierra Leone in 2014, killing 11,315 people. Despite being diagnosed in March 2014, there was a slow initial response to the epidemic. This was attributed by many witnesses to our inquiry to delays in WHO sounding the alarm and declaring a Public Health Emergency of International Concern (PHEIC), something which WHO must carry primary responsibility for. As a result, the international community did not fully mobilise until September, in the wake of the World Health Organization’s designation of the outbreak as a Public Health Emergency of International Concern in August. We praise those who risked their lives to bring the epidemic under control and pay tribute to all those who lost their lives in the fight against Ebola.

The Department for International Development (DFID) played a strong leading role in co-ordinating the response in Sierra Leone, but it responded late due to the WHO designation delay and an over-reliance on the international public health system to sound the alarm. Médecins sans Frontières raised serious alarm as early as June 2014.

We recommend that DFID in future should be able to react to warnings from a wider range of sources, not just the established international system.

DFID, in collaboration with the Ministry of Defence, Public Health England and the NHS, operated effectively once its response began in earnest. We commend this co­ ordinated response, which represents a fine example of cross-Government working.

We nevertheless wish to see improvements in DFID’s flexibility, especially in its ability to disburse small amounts of money early on in a crisis when it could be more cost-effective.

We were told throughout the inquiry about the importance of community engagement in achieving an effective response. Two significant factors in the spread of the disease were cultural practices, such as unsafe burial, and distrust in the authorities and health sector. We recommend therefore that DFID engage communities earlier in future outbreaks, especially through trusted local, tribal and faith leaders, established voluntary organisations and civil society. DFID could also use anthropologists to facilitate this. Now that the Ebola crisis is over, it is vital that every effort is made to eradicate FGM in Sierra Leone and worldwide.

The Ebola epidemic exposed serious deficiencies in the international public health system. The World Health Organization has acknowledged its shortcomings in dealing with the crisis and that it requires radical reform to improve its outbreak capacity. We agree and urge DFID to lead efforts and make this reform a priority. The International Health Regulations have also been shown to be inadequate. Many countries are not taking their legal obligations under the regulations seriously; and there are differences in understanding over the purpose of the designation of a Public Health Emergency of International Concern. We support the creation of a transparent and clearly understood grading system for public health emergencies.

What the government said

The government responded on 21 April 2016.

Summary written by Accountability Index from the government's response.

The government agrees that the international system needs "urgent and serious reform" and responds to the Committee's recommendations by agreeing with some, partially agreeing with others and disagreeing with one.

  • On recommendation 3 (small sums of money), the government disagrees, saying DFID "has appropriate mechanisms that allow very quick approval of funding", including a Rapid Response Facility that can commit funding within 72 hours.
  • On early warning (recommendation 1) the government partially agrees, recognising that triggers for action "could be made more systematic" and noting a new rapid response unit of public health specialists is "being established".
  • It agrees on WHO reform, stating the UK will "continue to engage in intergovernmental meetings on WHO Reform" and push for a clear financing strategy and strengthened accountability.
  • On the International Health Regulations it partially agrees, saying the Review Committee should focus on supporting implementation "rather than opening up the IHR for lengthy renegotiations"; that Committee reports to the World Health Assembly in May 2016.

Read the government's response ↗ Read the report ↗ Report an error

How the inquiry ran

Each dot is a dated item listed on this page, from the inquiry's opening on 13 July 2015 to 21 April 2016.

  1. Oral evidence 3 sessions
  2. Report 19 Jan 2016
  3. Government response 21 Apr 2016

What it recommended 2 recommendations · 19 conclusions

1As a result of WHO announcing a declaration of a Public Health Emergency of International...
Concluded (the committee's words)
As a result of WHO announcing a declaration of a Public Health Emergency of International Concern too late, DFID reacted slowly to early warnings, albeit from a limited number of actors, notably Médecins sans Frontières, that this outbreak of Ebola was on an unprecedented scale. Its initial delay was due to an over-reliance on the existing international public health system to sound the alarm at a political level. Improvements to global surveillance networks are needed and welcome. The fact remains that, in the case of the Ebola epidemic, warnings were given but were not heeded. Had they been heeded, DFID would have been able to respond much faster, as evidence shows from DFID’s response after the PHEIC was announced when the UK demonstrated strong and swift political leadership, which we commend. We note that improvements are being made to the international early-warning surveillance and response systems. We are concerned however that DFID is still relying too much on improvements to the international system, without improving its own ability to independently assess international public health risks.
2DFID must ensure that it has the ability to listen and react to information and...
Concluded (the committee's words)
DFID must ensure that it has the ability to listen and react to information and warnings from a range of sources, not just the World Health Organization, in order to assess the severity of public health and humanitarian emergencies.
3The UK Government should be commended for the way it responded after the declaration of...
Concluded (the committee's words)
The UK Government should be commended for the way it responded after the declaration of a Public Health Emergency of International Concern. In particular, we applaud all of the staff who worked in Sierra Leone and the region to bring the epidemic under control. The UK’s response to the Ebola crisis represents a very good example of cross-Government working, in terms of displaying the advantages of a co-ordinated effort as well as showing how such an effort can be well co-ordinated.
4We welcome DFID’s work with other departments to improve the UK’s readiness and capacity for...
Concluded (the committee's words)
We welcome DFID’s work with other departments to improve the UK’s readiness and capacity for future outbreaks and humanitarian emergencies; this work should continue and the lessons and best practice on cross-Government working learned from this response should be disseminated across Government.
5A recurring theme in our scrutiny of DFID is the difficulty it has in disbursing...
Concluded (the committee's words)
A recurring theme in our scrutiny of DFID is the difficulty it has in disbursing and managing small amounts of money. This issue was present at the start of the Ebola epidemic and may have hampered some early efforts to tackle the disease. Evidence suggests that small amounts of money disbursed at the start of a crisis, in order to bring that crisis under control quickly, can be very effective. In general small early interventions will deliver good value for money and can reduce the amount of money required further down the line. In contrast, a response that is playing catch­ up is very likely to cost more.
6DFID should ensure that it can operate more flexibly to respond to rapidly changing circumstances,...
Concluded (the committee's words)
DFID should ensure that it can operate more flexibly to respond to rapidly changing circumstances, including developing a mechanism to allow country offices to authorise the spending of small amounts of money without fear of negative consequences. This should apply not only during crises, and should involve devising easier means for applications to DFID to be made for smaller sums.
7Engaging communities early is vital to responding to a public health emergency.
Concluded (the committee's words)
Engaging communities early is vital to responding to a public health emergency. It is unhelpful just to see cultural practices as a barrier to tackling an outbreak, as this can foster distrust between medical professionals and communities. Local and faith leaders can provide a valuable avenue for spreading important public health information and good practices.
8In future outbreak responses, DFID must engage communities early and build community engagement into the...
Concluded (the committee's words)
In future outbreak responses, DFID must engage communities early and build community engagement into the fundamentals of its response. To assist with this, DFID should build its anthropological capacity and work with anthropologists in its work on strengthening health systems and on outbreak response. This would help it better understand the ways that people access and comprehend health services, so that it can build appropriately. To further facilitate this, DFID should also work more closely with local civil society and voluntary organisations, many of whom have long- established relationships with local communities over many years.
9Weak health systems in the affected countries were a major factor in the rapid spread...
Concluded (the committee's words)
Weak health systems in the affected countries were a major factor in the rapid spread of Ebola. Robust health systems do not just allow for better control of an outbreak, but also for better treatment of more conventional illnesses, minimising the overall effect. The importance of a broad approach of building quality health systems for the sake of good health itself is recognised in the Sustainable Development Goals.
10Health systems strengthening should form a core part of recovery efforts in the affected countries.
Concluded (the committee's words)
Health systems strengthening should form a core part of recovery efforts in the affected countries. DFID should use its position as a world leader on health systems strengthening to ensure that this is the case and to press for affected countries themselves to invest in and take ownership of improving their health systems. It should push for an intelligent approach to implementation of Sustainable Development Goal 3 which focuses on building robust health systems, taking into account how those systems work as a whole and how people access those services, and share its expertise in this area with other countries and partners to maintain that focus.
11We welcome the UK’s commitment to research and development into infectious diseases through the Ross...
Concluded (the committee's words)
We welcome the UK’s commitment to research and development into infectious diseases through the Ross Fund. We look forward to the publication of the Science and Technology Committee’s report on Science in emergencies: UK lessons from Ebola.
12Development after the Ebola epidemic is a complex and daunting task, and the aim should...
Concluded (the committee's words)
Development after the Ebola epidemic is a complex and daunting task, and the aim should not just be to restore Sierra Leone to its pre-Ebola situation, but to take the opportunity to rebuild and develop further. DFID has made a clear commitment to development in Sierra Leone, which we welcome and commend. We judge DFID’s focus on economic development and basic services to be correctly placed to support the objective of development to a higher level, although a greater emphasis is needed on long-term support for education.
13In order to fully achieve this, though, DFID’s commitment must be a long-term one.
Recommended (the committee's words)
In order to fully achieve this, though, DFID’s commitment must be a long-term one. In addition, and in light of the Government’s new aid strategy, we urge DFID to ensure that strengthening health and education systems remain high priorities for the Department across its portfolio.
14The World Health Organization has acknowledged its shortcomings in dealing with the Ebola epidemic, due...
Concluded (the committee's words)
The World Health Organization has acknowledged its shortcomings in dealing with the Ebola epidemic, due to inadequate funding, a structure which was ill-suited to responding to such a crisis, and a reform process which has been too slow to achieve results. This is a failing on the part of the international community and all of its Member States, including the UK. WHO needs radical reform and quickly. We fully endorse the proposals which have been put forward by both the Ebola Interim Assessment Panel and the Independent Panel on the Global Response to Ebola, and stress that these need to be implemented with great urgency.
15The UK should lead efforts for radical reform of the World Health Organization, including for...
Concluded (the committee's words)
The UK should lead efforts for radical reform of the World Health Organization, including for greater funding from its Member States; it should maintain the pressure on WHO to be efficient and effective, even after the reforms are achieved, to ensure that it can properly fulfil its role as the lead organisation for responding to public health emergencies. We ask that DFID give us regular updates on the progress of the reform process, beginning with the response to this report.
16International health security requires that countries take their obligations under the International Health Regulations seriously;...
Concluded (the committee's words)
International health security requires that countries take their obligations under the International Health Regulations seriously; this requires the current review process to come up with meaningful reform. In addition, there is a clear difference of understanding, between the World Health Organization and others, in what purpose a declaration of a Public Health Emergency of International Concern serves. A clear warning system for public health emergencies is needed, to facilitate the political escalation of a crisis and mobilise the international community when necessary.
17DFID should work to make sure that the countries in which it works take their...
Concluded (the committee's words)
DFID should work to make sure that the countries in which it works take their obligations under the International Health Regulations seriously and commit fully to implementing the core capacities. As part of the process of reform of the International Health Regulations, the UK should press for a more transparent and clearly understood grading system for public health emergencies.
18We are grateful to our predecessor International Development Committee for laying the foundations for this...
Concluded (the committee's words)
We are grateful to our predecessor International Development Committee for laying the foundations for this inquiry. Its reports on Strengthening Health Systems in Developing Countries and Recovery and Development in Sierra Leone and Liberia were not only topical, but identified many of the issues explored in this report long before they became as apparent as they are now. It is clear that many of those issues still require addressing.
19We reiterate all of the recommendations made in those reports, especially with regards to ensuring...
Recommended (the committee's words)
We reiterate all of the recommendations made in those reports, especially with regards to ensuring that DFID’s health systems strengthening objectives are met and the need for DFID to take on a leadership role in pushing for health systems strengthening. DFID should provide us with an update on its progress against those recommendations.
20The Ebola epidemic has acted as a practical test of the international community’s ability to...
Concluded (the committee's words)
The Ebola epidemic has acted as a practical test of the international community’s ability to respond to a public health emergency. It has exposed great weaknesses across the international system. This is especially unfortunate considering the remarkable effectiveness of the response after it had been scaled up. However, that mobilisation came far too late, by which point the response was already playing catch up.
21If any good is to come of the outbreak it must be that, in operating...
Concluded (the committee's words)
If any good is to come of the outbreak it must be that, in operating as a practical test, it has functioned as a stark wake-up call to the international community. The first priority must be to ensure a fully functioning international system for responding to public health emergencies, through reform of WHO and the International Health Regulations. However, DFID cannot only rely on these reforms and must improve its ability to independently recognise public health emergencies in the countries in which it operates, and continue to build on its own ability to respond. Responsibility for identifying and reacting rapidly to such events rests with the entire international community, including the UK. Such an outbreak can never be allowed to occur again, or to develop so catastrophically due to international inaction.

Evidence

Oral evidence sessions 3