Statement by Minister Varadkar – Update on the Threat of the Ebola Virus

Statement by Minister Varadkar to Joint Oireachtas Committee on Health and Children

Update on the Threat of the Ebola Virus

Mr Chairman, Deputies, Senators, I welcome the opportunity to brief you this morning on preparedness for Ebola virus disease (EVD) in Ireland. I am joined by Dr Tony Holohan, Chief Medical Officer (CMO).

In this statement, I propose to discuss high level arrangements that are in place to deal with public health threats and the major elements of our Ebola preparedness.  Dr Holohan and I will be happy to take any questions you may have.

As of Monday, there were 4,033 confirmed deaths and 8,399 confirmed, probable and suspected cases of Ebola in 7 countries although widespread transmission is confirmed to three; Liberia, Sierra Leone and Guinea. The number is doubling every 3 to 4 weeks. The UN has declared the outbreak to be an international public health emergency. As President Obama said yesterday, the most effective thing we can do is to halt the rise of the diseases in West Africa. This is the single most effective thing we can do to prevent the spread of the disease to Europe and Ireland. That’s why I publicly want to commend the volunteers, staff and aid agencies working on the ground in West Africa. Ireland has pledged over €2.5m to the effort to the International Medical Corps (IMC), Concern, GOAL, World Vision, International Rescue Committee and the Ministry of Health in Liberia.

We have also provided 42 tonnes of equipment including blankets, tarpaulin, tents, nets, soap and water tanks. My Department deployed 2 public health specialists to work with the WHO in Liberia and Nigeria.

The European Centre for Disease Prevention and Control (ECDC), in its latest risk assessment (13/10/14), concluded that the risk of a case in the EU is considered to be low. However, the increase in cases in the affected countries means that the risk of a case being imported into Europe has increased.

Environmental conditions in Ireland, however, do not support the natural reservoirs or vectors of any of the viruses that cause viral haemorrhagic fever (VHF).  Given appropriate infection control, the risk of transmission of Ebola in Ireland is considered very low.

Should a case occur, it is likely that there will be only one or two cases and they can be handled in the National Isolation Unit in the Mater. There is no reason to believe that Emergency Departments will be swamped or services overwhelmed. This has not happened to date in any western country or indeed in more developed African ones, like Nigeria, where an outbreak was successfully contained. That is not to say that there will not be several suspect cases and we need to learn from experience in other countries.

The Committee will know that Simon Coveney, in his capacity as Minister for Defence, chairs the Government Task Force on Emergency Planning which comprises Ministers and senior officials of Government Departments and public authorities, senior officers of an Garda Síochána,  the Defence Forces, and officials of other key public authorities which have a lead or support role in Government emergency planning.

The Government Task Force is the top-level structure which gives policy and direction, and which coordinates and oversees the emergency planning activities of all Government departments and public authorities. It promotes the best possible use of resources and compatibility among different planning requirements.

Preparedness for major public health emergencies is a critical function of the health service and of the whole of Government.  Emergency Planning in Ireland is structured around the “Lead Government Department” principle.

There are currently 41 emergency types, each with a Lead Government Department set out in Annex ‘A’ to Strategic Emergency Planning Guidance.  The Government Department that is responsible for an activity in normal conditions retains that responsibility during a major emergency.

In accordance with established procedures and as agreed by Government, the Lead Government Department is responsible for coordinating the whole of Government response to a particular emergency and chairs the National Co-ordination Group in relation to that emergency.

The Department of Health is currently the Lead Government Department for two emergency types:

•       Pandemic influenza and other public health emergencies

•       Biological incidents (where incident is primarily a public health incident).

Swine Flu is a good example where the response was managed and led by the Department of Health with input, where necessary, from others.

Ebola virus disease is another example.  The national response can be divided into two components, the first is the health service response which will be the main subject of my opening statement and secondly, other specific elements of preparedness that are the responsibility of other line Ministers.

Let me firstly deal with the latter.  My colleague, the Minister for Foreign Affairs and Trade has lead responsibility for emergencies abroad involving Irish citizens. His Department has issued detailed travel advices for the affected countries and continues to work actively with my Department, the EU and international partners on contingency plans for Irish citizens abroad. In addition, Minister of State Sean Sherlock, through Irish Aid has been managing Ireland’s development and humanitarian response to the crisis.

In relation to ports and airports, the Port Health Group in their role as Medical Officers of Health has had regular meetings with port authorities in their jurisdiction. Updates on the Ebola outbreak in 2014 have been sent to the Environmental port health officers. Protocols are in place for viral haemorrhagic fever risk assessment by ambulance personnel at airports and shipping ports. Minister Paschal Donohoe has specific responsibility for ports and has assisted in ensuring that information requirements at both sea and airports are in place in line with the international advice provided.

The health service response is the major element of Ireland’s national Ebola preparedness.  Firstly, it provides the expert advice and guidance to other Departments, secondly, it puts in place the specific arrangements for an appropriate public health and clinical response to any case that might arise in this country.

Chairman, it may be helpful for me to go through the major elements of our Ebola preparedness.

Firstly, the epidemiological situation is assessed on a continuing basis using international data from ECDC and from the WHO.  This helps to inform both the international risk assessments conducted by ECDC and also national level risk assessments that are specific to Ireland.

The EU Decision on serious cross-border threats to health, agreed under the Irish Presidency, came into force in November 2013.  The Decision provides a coherent framework for tackling all serious cross-border public health threats by addressing three main areas:

  1. preparedness and response planning
  2. Risk monitoring and assessment
  3. Risk management and crisis communication.

Ireland is represented on the EU Health Security Committee, which was set up to co-ordinate health threats at EU level by officials from the Department of Health.  This is chaired by the EU Commission and all 28 Member States are represented. Teleconferences have been held regularly on Ebola since April 2014, with the latest held on 14th October.

The Health Service Executive Emerging Viral Threats Group and the Ebola Scientific Advisory Group have met recently to review the situation and approve national guidance for Ebola and other emerging viral threats to health.  Late last week, the CMO chaired a meeting of the National Public Health Emergency Team (NPHET) to discuss the issue.  In addition, I know that the office of the CMO has been in regular communication with colleagues in Northern Ireland to discuss national and international developments.

The matter was also discussed in Milan, last month, at the informal Council of Ministers meeting, which I attended. The Health Protection Surveillance Centre (HPSC) has issued  guidance to hospitals and GPs, including an algorithm for the assessment of VHFs and clinical assessment forms and advice for healthcare workers. These include humanitarian aid workers, returning to or coming to Ireland following travel from an area affected by the Ebola Virus Disease.

Extensive information has been provided for hospital clinicians, general practitioners and other healthcare workers to enable rapid identification of suspected Ebola patients in other settings, and their urgent management by the HPSC.

Healthcare staff in the National Isolation Unit (NIU) and hospitals around the country have received information and advice on identification and management of EVD.

There is also extensive guidance relating to infection prevention and control which clearly describes the steps that staff must take to ensure that they protect themselves and other patients in the event of the presentation of a case or suspected case of Ebola.

The HSE has distributed Personal Protective Equipment packs to GP practices and out of hours services. Many will have them anyway from previous threats.

The HSE has been active in informing the public about the disease. It has produced specific information for travellers and people who have returned recently from affected areas and information posters are on display in airports. Advice has also been distributed to airports and ports and to educational settings.

The issue of airport screening has been raised. This has been the subject of extensive discussion at EU level. At the most recent meeting of the EU Health Security Committee, a number of options for inward screening at airports for Ebola were discussed.

It remains the view, based on advice from ECDC, that it is far more effective to support the implementation of exit screening in affected countries. However, it was noted that the provision of clear information to passengers from affected countries, particularly on symptoms and how to access health care, are important measures in preventing the spread of the disease.

I would like to specifically address the concerns that have been raised by unions in recent days.  It is reasonable that healthcare workers will be concerned about risk of transmission  to them of such an infectious and virulent disease as Ebola.  Though unlikely, it is possible as we have seen in Spain and Texas.  For this reason, we are further stepping up preparedness, in particular training, dry-runs and provision of equipment. It is vital that we have the cooperation and commitment of our frontline healthcare professionals to enable us to respond appropriately.  I know meetings have been arranged with the HSE and in fact a meeting took place yesterday. Hopefully, concerns can be allayed, further actions taken and we can all reassure the public that Ireland is prepared.

In conclusion, considerable public health planning is underway with a range of bodies and professionals about the implications of the Ebola emergency in West Africa.

My Department will continue to work closely with the HSE, other Government departments, EU Member States and the WHO to coordinate measures to tackle the Ebola epidemic and to protect Irish citizens.