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Ebola

– in the Scottish Parliament on 28th October 2014.

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Photo of Tricia Marwick Tricia Marwick None

The next item of business is a statement by Alex Neil on an update on Ebola. The cabinet secretary will take questions at the end of his statement. There should therefore be no interventions or interruptions.

Photo of Alex Neil Alex Neil Scottish National Party

I am grateful for the opportunity to update Parliament today on the important issue of Ebola.

Members will be aware that we responded to questions on the subject in the chamber earlier this year. Last week, I provided an update in writing to the Opposition health spokespeople and the Health and Sport Committee. However, the outbreak of Ebola in west Africa is an issue of such international importance that it is right and proper that I make a statement to provide reassurance on where Scotland stands.

The situation in west Africa is grave. What we are seeing is nothing short of a public health disaster in the affected countries. The World Health Organization publishes weekly updates on cases and deaths, and the latest information, from 25 October, is that there have been a total of 10,141 cases of Ebola with 4,922 deaths.

Historically, the disease has been confined to rural and more dispersed communities in central Africa, where it cannot easily take hold. However, the outbreak in west Africa is affecting urban communities with large, densely-packed populations—areas where people move about regularly—and countries that, to varying degrees, face challenges in health infrastructure and leadership. Once Ebola had a finger hold in that part of the continent earlier this year, it began to spread very rapidly, and there is no sign yet that the epidemic is under control.

We in Scotland will play our full part in contributing to the international effort, along with our friends in the rest of the United Kingdom and elsewhere, to bring Ebola under control in west Africa.

More than 50 professionals from the national health service in Scotland have offered to help, and some are already in situ in west Africa. Nevertheless, it is likely that more support will be needed. I wrote to NHS chief executives on 16 October to reiterate our support for volunteers and particularly to identify the need for more nurses and laboratory staff.

I extend my sincere thanks to the Scottish aid workers who are operating in the region and the many healthcare workers and other staff who have expressed a willingness to volunteer in west Africa. We need to know that all our volunteers who travel to west Africa will be safe, and I am reassured that robust arrangements are in place to ensure that in partnership with Health Protection Scotland. We know who is going to west Africa; we know that they will be trained well both before they go and when they arrive; we are confident that they will be looked after when they are there; and we know that they will be monitored and supported when they return.

In Scotland, we are lucky enough to have the resources and infrastructure, and the public health expertise and experience, to be in a good position to deal with any serious infectious diseases, but we are not complacent. There has been an increase in concern about Ebola in the past few weeks, prompted by the reports of transmissions of the disease to healthcare staff in Spain and the United States. However, it is important that we understand the reality of the risk—the fear of Ebola can be more infectious than the virus itself.

The risk of a case arriving in Scotland is very low. There are no direct flights to Scotland from the affected countries, and robust exit screening is now in place in the three affected countries. Entrance screening is in place at Heathrow and Gatwick as well as in key European hubs such as Paris and Brussels.

Even if a case does appear in Scotland or the UK, it is very unlikely that we will see any transmission of the virus. The disease can be caught only through blood and other body fluids, and affected individuals will be unwell and will have a fever and other symptoms that are not infectious but will lead them to healthcare well before they are likely to pass the virus to other people. Indeed, the greatest risk of Ebola is to healthcare workers, because they are more likely to come into contact with body fluids when treating a patient.

We must keep the risks in perspective, but we must also be ready to respond. That is why we have been working with the NHS to ensure that it is prepared and ready. My colleague Michael Matheson, the Minister for Public Health, has led that work since early summer, when he met experts from Health Protection Scotland. Following that, we established a viral haemorrhagic fevers national group, chaired by Health Protection Scotland, to ensure that all the necessary arrangements and contingency plans are in place. That group met for the first time in August, and last week it started to meet on a weekly basis.

Given the importance of ensuring that we can quickly identify and diagnose possible cases of Ebola, we have provided funding to NHS Lothian to introduce a national testing service for viral haemorrhagic fevers in Scotland. That service, which will be in place from 1 December, means that blood samples will no longer need to be sent to the south of England for testing and we will get the results more quickly.

We are also working closely with the infectious disease clinical community to ensure that the facilities and resources are in place to rapidly respond to any potential case. Our main infectious disease units in Glasgow and Lanarkshire in the west, Edinburgh in the east and Aberdeen in the north are ready to operate as regional centres of expertise, providing advice to other local hospitals or clinicians as needed and managing possible cases.

Our many other infectious disease specialists and wards around Scotland are also ready to respond if needed. I am confident that we are ready to safely manage any possible case, should one emerge. Indeed, we have already shown that our health boards, working with the Scottish Ambulance Service and others, can safely manage such types of infection. We safely managed a case of Crimean-Congo haemorrhagic fever in Glasgow in 2012. We have 14 isolation rooms available to manage patients with Ebola in the three regional infectious disease units in Scotland, and we have access to many more specialist facilities across the UK.

An important strand of our work is ensuring that everybody across the NHS in Scotland and any other relevant professionals have all the information that they need, and I am grateful to Health Protection Scotland and the other professionals involved for all the work that they have done in the past few months to update the many different pieces of guidance and technical advice in relation to Ebola. That information is all available on the Health Protection Scotland website, and I encourage all health professionals to ensure that they are familiar with the content, as it is very likely that any questions that they have will already have been answered.

I have already mentioned the entry screening that is in place in the UK and European hubs. I am in regular contact with my ministerial contacts in the rest of the UK in the Scotland Office and the Department of Health, and we will keep under review the need for any additional entry screening, including in Scotland. I am not yet convinced that that is proportionate or necessary, but I am ready to implement screening if our assessment changes.

We have to make sure that our international partners across Europe are keeping under review the question of screening and other public health measures. Discussions are already taking place at a European level on all those matters. In addition, we are working with the oil and gas industry to ensure that any of our oil and gas workers who come from or go to affected countries will have access to the same type and quality of monitoring arrangements that are in place for medical volunteers.

That international, joined-up approach is vital if we are to successfully tackle the outbreak. Across the world, countries need to pull together, and we in Scotland are keen to play our part.

Earlier this year, the Scottish Government donated £0.5 million to the World Health Organization’s Ebola response. That was not a one-off gesture. Last week, I announced an additional donation of £300,000-worth of medical equipment and supplies to west Africa from Scotland. That includes more than 100,000 respirators and 1 million disposable aprons, which will be distributed to charities that run clinics in Sierra Leone. I will continue to ensure that we offer every assistance that we can to the international effort. The best way for us to protect public health in Scotland is to support the efforts that are under way in west Africa.

I hope that I have provided sufficient reassurance that we are monitoring the situation closely and that we take the public health of Scotland very seriously. The Government’s resilience committee, SGoRR, which is chaired by the First Minister, has already met three times on this matter. That has provided an opportunity for us to engage with the Scottish experts and to ensure direct Government oversight of our preparedness.

We will continue to be vigilant and alert, and we will maintain our links with other parts of the UK to ensure a joined-up approach. The public should be reassured that the risk of Ebola coming to Scotland is still very low but, if it arrives here, the NHS is ready to respond and public health will be protected.

Photo of Tricia Marwick Tricia Marwick None

The cabinet secretary will now take questions on the issues raised in his statement. I intend to leave about 20 minutes for questions, after which we will move on to the next item of business.

Photo of Neil Findlay Neil Findlay Labour

I thank the cabinet secretary for his comprehensive statement and his response to my earlier letter appealing for MSPs to be kept updated on Ebola and any impact on Scotland or Scots. I pay tribute to the 50 NHS professionals working in the affected region and the non-governmental organisations and their volunteers who are there doing tremendous work in a very difficult situation.

I want to ask the cabinet secretary about the level of training being provided to staff on dealing with the disease prior to leaving for and then entering the affected area. What support will be provided to them when they are there and on their return? What support and co-operation is being given to Scottish-African charities working here and with people in Sierra Leone to help prevent the spread of the disease and deal with the consequences of it?

Today, I met representatives of some of the Scottish-African charities, and they asked me whether I could put forward a request to the minister for him to meet them so that they could discuss ways in which they could work together with the Scottish Government in order to help deal with the situation on the ground and some of the consequences of that, including things like education. I would really appreciate it if the minister could take me up on that offer.

Photo of Alex Neil Alex Neil Scottish National Party

My colleagues Michael Matheson and Humza Yousaf and I are planning to meet the NGOs involved and, indeed, other organisations whose support we require—although some of the organisations may not be NGOs working in Africa, they may nevertheless be able to help with the supply of material.

We have now received a request from Oxfam for additional support as well as the Department for International Development list, which we are working our way through. Therefore, we would be more than happy to meet and are planning to meet the NGOs and, indeed, others as well. This has to be a joint effort: it is not just about the Scottish Government but about all the people who can make a contribution.

In terms of the staff who have gone, the latest number that I have is that 59 staff have volunteered from Scotland. Of them, 31 are doctors, 17 are nurses, seven are paramedics, three are lab technicians and one person is of unknown skill but has nevertheless volunteered. Prior to assignment in west Africa, those healthcare workers participate in a three-stage training programme that includes five days of training in a facility in the UK and three days of training in the relevant facility on arrival in west Africa. In our case, that will be in Sierra Leone because part of the international agreement is that the UK Government will lead the effort internationally in Sierra Leone while, for example, the United States Government leads the international effort of other Governments in Liberia. We have obviously agreed with the UK Government that we will focus our efforts in support of it in Sierra Leone, which we are doing.

The arrangements for monitoring the staff’s healthcare in situ are under the auspices of Public Health England. It has been agreed by the four Administrations in the UK that Public Health England will be the lead agency for co-ordinating the arrangements and acting as a conduit for them. It has offered to register any aid worker from the UK, wherever they are based, as they are doing with NHS volunteers from across the UK. Public Health England registers the aid worker before they leave, tracks them when they are there, performs a risk assessment on their return as regards exposure to Ebola and sets up a monitoring system as well. I believe that a total of 12 beds have been allocated in Sierra Leone, which are ring fenced for any health worker working in the area—not just UK health workers—who happens to contract Ebola.

I am happy to send any member more details, because I have volumes of details on the arrangements. However, I can assure the chamber that, in terms of the training and looking after the health and wellbeing of the volunteers when they are in the countries concerned, we now have a very comprehensive package that is similar to that for the rest of the UK.

Photo of Nanette Milne Nanette Milne Conservative

I welcome the statement, which brings us up to date with the action that is being taken to combat the Ebola outbreak, and I thank the cabinet secretary for an advance copy of it. I, too, thank all the healthcare professionals who have volunteered to help in affected areas.

The cabinet secretary will be aware of recent comments by Dr Devi Sridhar, senior lecturer in global health policy at the University of Edinburgh, that if Ebola comes to Scotland my home city of Aberdeen is likely to be at risk, given its airport and its concentration of population with international connections. As Aberdeen royal infirmary is one of the four centres in Scotland with a dedicated infectious diseases unit, will the cabinet secretary ensure that it receives adequate resources and support, should there be a case of Ebola in the north-east?

As a north-east member, I clearly welcome the cabinet secretary’s comment that he is working closely with the oil and gas industry to protect workers in that industry, but is he fully confident that the necessary precautions are in place for those returning to the UK who have been engaged in countries overseas that are affected by the virus? Will workers returning from such countries be prohibited from going on to installations in the North Sea until it is certain that they have not been infected?

Photo of Alex Neil Alex Neil Scottish National Party

I am happy to reassure the member on a whole host of points. On her last question, we have agreed with the oil and gas sector that no worker who returns from one of these countries will go back on to an oil rig in less than 21 days of arriving in the country. The reason for the 21-day period is that that is, of course, the incubation period for Ebola.

Perhaps I can take the chamber very quickly through the processes that each oil worker coming from west Africa to the UK will go through. After all, that is where the main risk will be, and Aberdeen with its oil workers is the area within Scotland that is most likely to be affected.

First of all, there is a full exit screening process that people must go through before they leave any of the countries involved, and if they show any signs whatsoever of the disease, certain clinical judgments will be made. To date, all those suspected of having Ebola, with one exception, have not travelled and have been treated in the country. Again, that situation is very much under the control of the UK Government in agreement with the affected countries and as part of the practice that is being adopted internationally. It is therefore likely that for any oil worker suspected of having Ebola the clinical decision will be to deal with them in country and ensure that they get the same treatment there that they would get back at home in the UK. To date, only one case—who, as you will know, was not an oil worker, but a nurse—has come to London, and that chap successfully recovered from Ebola.

Once the oil worker goes through exit screening—and assuming that they have not been identified as having Ebola—they will get on their flight. The three main routes from west Africa into the UK are via Casablanca, Brussels and Paris, and the flights primarily go into Heathrow, with a small number going to Gatwick. A small number of individuals will also go through St Pancras station, where there is also a screening process. Anyone arriving at Heathrow, Gatwick or St Pancras who has been to one of those countries will go through an entry screening process and for those with a temperature—or, indeed, for those about whom there is any worry at all, even if they have recently arrived in the country—there is a tracking process in which they are followed up and monitored for up to 21 days.

On the subject of oil workers, we are working very closely with Oil & Gas UK and the industry, because two companies that operate in the North Sea also operate in the affected region. I should point out, however, that most of the oil in that region comes from Nigeria, which is now Ebola free, so the risks should be absolutely minimal. Just in case, however, we are working very closely with the oil companies, particularly the two that have installations in the North Sea and west Africa, and with NHS Grampian to ensure that all the facilities are in place in Aberdeen to absolutely minimise any chance of an oil worker or indeed anyone else contracting Ebola.

Photo of Linda Fabiani Linda Fabiani Scottish National Party

Although I was very pleased to hear that the Scottish Government is working alongside so many others, we are very much talking about a reactive situation, and there have been discussions about whether the international community was caught a bit off guard on this issue.

I recognise that it is always better to take a preventive approach to such issues in developing countries. With that in mind, I am interested to know about the collaborative international research that is going on, and the information and training programmes that are being put in place in affected countries. What discussions are taking place on that just now? There are many reasons, to do with cultural practices as well as health infrastructure, why such diseases cannot be contained quickly when they break out.

Photo of Alex Neil Alex Neil Scottish National Party

There are many in-country initiatives in place. One problem is the cultural opposition in affected countries to the cremation of dead bodies, as burial poses a particular risk. Initiatives are in place to try to minimise any risk as a result of the cultural problems arising from wide-scale cremation.

With regard to the wider picture, I will make two points about vaccines, which I did not mention in my previous answers. Two vaccines are about ready for distribution at the turn of the year. Initially, they will be distributed in small numbers—20,000 units in January—but more than 1 million units will be distributed by April.

As members will be aware, there is a global agreement to fast-track the approval process for those vaccines. If we had to wait for them to go through the normal processes, it would be years before we could use them. The most advanced vaccine is being produced by GlaxoSmithKline, but there is also a Canadian vaccine that is about ready to go.

Those vaccines will obviously be tested for side effects and so on before they are finally used. The good news is that there is now a high expectation that a vaccine will be available at some point in the first half of 2015. It has also been agreed globally—very sensibly, I think—that the top priority group for vaccination will, for obvious reasons, be the health workers who are working in west African countries.

The jury is out on the effectiveness of the drug ZMapp, which has received widespread publicity. In any case, there are currently no more supplies of it worldwide, as the last supply was used by a Norwegian patient two weeks ago, and the drug is based on plants, which take some time to grow. A lot of effort is going on internationally to determine the safety of the vaccines and to make them widely available as early as possible, and to investigate possible cures for Ebola.

In among all the bad news, there is a degree of optimism that by this time next year vaccines will be widely available, in west Africa in particular.

Photo of Richard Simpson Richard Simpson Labour

I join other members in thanking the cabinet secretary for his comprehensive statement and clarity in tackling the issue.

It is good that our health service has already had experience of dealing with Crimean-Congo haemorrhagic fever. What risk assessment has been carried out with regard to demand for the 14 isolation rooms and associated equipment during a normal winter? It is predicted that the Ebola outbreak could well last into 2016, and the growth curve will not stop at least until summer next year. What training and equipment is being made available to ambulance workers?

Photo of Alex Neil Alex Neil Scottish National Party

We are currently finalising a contingency plan for the worst-case scenario: a situation in which there is much higher demand, particularly if we end up dealing with more than one—or even just one—Ebola case. Under the current procedure, if someone has come from west Africa and is identified as being affected by Ebola, and if there is a clinical decision—and it will be a clinical decision—to transport them to the UK, they will go initially to the Royal Free hospital in London. Once it is appropriate, they will be transported to one of the infectious disease units in Scotland.

We have in place a whole host of procedures and training, not specifically for Ebola but for haemorrhagic fevers. That provision was increased quite considerably two years ago when we dealt with the Crimean-Congo fever case. My colleague Michael Matheson has been working on those arrangements with all the relevant professionals since the start of the summer, and training and risk assessment are built into our on-going work across the board.

Photo of Tricia Marwick Tricia Marwick None

We have very little time left for questions on this important statement. I would appreciate short questions and short answers, cabinet secretary.

Photo of Bob Doris Bob Doris Scottish National Party

I commend the Scottish Government on its preparedness in relation to this matter. There are various places where, in theory, Ebola could spread, such as schools and higher education establishments in Scotland. Whilst, theoretically, the chances are very limited, has the cabinet secretary been in contact with further and higher educations and schools to talk about the actions that they would have to take to play their part?

Photo of Alex Neil Alex Neil Scottish National Party

Absolutely. We have been in touch with local authorities, schools and every college and university in Scotland. We have paid particular attention to being in direct contact with every university or college where the 30 students in Scotland from the affected countries in west Africa are studying, and we are in touch with those people through their college or university to make sure that they are well aware of the risks, and in particular, so that they let us know if they or any of their friends or family are travelling to or from west Africa, so that we can monitor their situation.

We have categorised the groups of people at the highest risk. Oil and gas workers are obviously at the top of that list because of their numbers. There are a small number of students and people from the indigenous population, and we are in touch with them. The acting chief medical officer has made every general practitioner in Scotland aware of what needs to be done if Ebola is suspected, as have those in appropriate other outlets. I think that we have covered every possible avenue, and the acting chief medical officer will remind people regularly until any potential threat from Ebola is completely eradicated.

Photo of Jim Hume Jim Hume Liberal Democrat

I thank the cabinet secretary for advance sight of his statement and I also thank the NHS staff and others who have, not without risk to themselves, volunteered to go out to tackle Ebola.

The minister has stated that he does not believe that it would be proportionate or necessary to implement screening here in Scotland and I agree with him on that. However, what criteria will he use in his on-going assessments and what will need to happen before screening is considered to be necessary?

Photo of Alex Neil Alex Neil Scottish National Party

Point-of-entry screening is already being done in London. I think that I am right in saying that 85 per cent of those who fly in directly from west African countries come through Heathrow, and the balance come through Gatwick and St Pancras. Very comprehensive screening is being done there.

We are in regular touch with the Scotland Office and the Department of Health, in particular with the minister for public health, Jane Ellison. They are going through an exercise to establish whether they will extend screening to regional airports in England, and there is a set of criteria and an assessment methodology for that. We are working with them and will keep the situation under review.

I think that I am right in saying that, at the moment, there is no additional screening in regional airports in England, although some consideration has been given to it. There are very clear assessment criteria, and I or Mr Matheson will be happy to send more details to the member. It would take me quite a while to go through all those criteria and assessments.

Photo of Gil Paterson Gil Paterson Scottish National Party

The cabinet secretary said that guidance has been sent to health professionals to ensure that they are equipped to deal with any suspected cases. What information will be provided to pharmacists, particularly on recognising potential cases?

Photo of Alex Neil Alex Neil Scottish National Party

The acting chief medical officer and the chief pharmaceutical officer are informing the pharmacy industry through various sources, particularly the health boards, of anything that they need to be aware of, so that everybody who is involved in medical care or healthcare of any type in Scotland is fully aware of the signs, risks and procedures should they suspect anyone of having Ebola.

Photo of Patricia Ferguson Patricia Ferguson Labour

I thank the cabinet secretary for his comprehensive statement. I agree with him when he says that the best way for us to protect public health in Scotland is to support the efforts that are under way in west Africa.

Having recently visited Cameroon and having been screened on entry to that country, I can testify to the seriousness with which the countries in west Africa are taking this particular outbreak. I applaud the funding and supplies that have been made available by the Scottish Government, but the task of fighting Ebola is falling to countries that struggle continually to provide a health service to their citizens in the normal course of events. I wonder whether the Scottish Government might look at ways of helping to provide assistance to the most affected west African countries, in order to sustain the health services that the people within those countries need in their daily lives.

Photo of Alex Neil Alex Neil Scottish National Party

As I said in my statement, we have already shipped out £300,000-worth of aprons, masks and so on, but it is not just what is in store in Larkhall for the NHS in Scotland that we are shipping. We are working to a list prepared by DFID and the priority at the moment is for stuff that is required to deal with Ebola in the hospitals and in the clinics in the affected countries. Once we have broken the back of that, we will look at the longer-term situation and how we can help.

We have already sent money—we sent £500,000 through the WHO—but rather than us trying to reinvent the wheel, we are working through established international organisations such as the WHO. We are working closely with DFID, with Oxfam and with other organisations as well. We will respond to the Oxfam request very positively. When a request comes in for longer-term assistance, clearly Mr Yousaf, Mr Matheson and I will do what we can to provide anything that we possibly can to help those people, because the health service is, quite frankly, pretty primitive in the affected countries.

Indeed, I have asked Mr Matheson and Mr Yousaf, along with a small number of officials, to visit west Africa at an appropriate time and to identify any additional help that Scotland can provide, because I agree with the member that we should be doing everything that we can not just to help those countries over this Ebola crisis but to help them to avoid such a crisis happening again and to build up a better healthcare system.

Photo of Tricia Marwick Tricia Marwick None

My apologies to the two members I was unable to call.