REPORT on the Ebola crisis: the long-term lessons and how to strengthen health systems in developing countries to prevent future crises
1.10.2015 - (2014/2204(INI))
Committee on Development
Charles Goerens
MOTION FOR A EUROPEAN PARLIAMENT RESOLUTION
on the Ebola crisis: the long-term lessons and how to strengthen health systems in developing countries to prevent future crises
The European Parliament,
– having regard to United Nations Security Council Resolution 2177 (2014) of 18 September 2014 on peace and security in Africa,
– having regard to United Nations General Assembly Resolution 69/1 of 19 September 2014 on measures to contain and combat the recent Ebola outbreak in West Africa,
– having regard to the decision by the United Nations Secretary-General, Ban Ki-moon, to set up the organisation’s first emergency health mission, the UN Mission for Ebola Emergency Response (UNMEER), following the adoption of General Assembly Resolution 69/1 and Security Council Resolution 2177 (2014) on the Ebola epidemic,
– having regard to the World Health Organisation’s International Health Regulations (IHR) of 2005 (WA 32.1),
– having regard to the recommendations from the WHO’s consultation on zoonoses of 5 May 2004,
– having regard to the WHO’s statement of 8 August 2014 declaring the Ebola epidemic a public health emergency of international concern,
– having regard to the WHO’s Ebola response roadmap of 28 August 2014 and the updates thereto,
– having regard to the Director-General of the WHO’s report to the Executive Council at its extraordinary session on Ebola held in Geneva on 25 January 2015,
– having regard to the WHO’s statement of 9 May 2015 on the end of the epidemic of the Ebola virus in Liberia,
– having regard to the Guidance for Immunization Programmes in the African Region in the Context of Ebola, issued by the WHO,
– having regard to the statement made following the spring 2015 meeting of the World Bank Group and the International Monetary Fund held in Washington DC from 17 to 19 April 2015,
– having regard to the international conference entitled ‘Ebola: from emergency to recovery’ held in Brussels on 3 March 2015,
– having regard to the establishment by the African Union of the African Union Support to Ebola Outbreak in West Africa (ASEOWA) mission on 21 August 2014,
– having regard to Regulation (EU) No 1291/2013 of 11 December 2013 establishing Horizon 2020 – the Framework Programme for Research and Innovation (2014-2020),
– having regard to the Commission communication COM(2010)0128 together with SEC(2010)0380, 0381 and 0382 on the EU Role in Global Health,
– having regard to the European Council conclusions of 24 October 2014,
– having regard to the Council conclusions on the EU Role in Global Health of the 3011th Foreign Affairs Council meeting in Brussels on 10 May 2010,
– having regard to the conclusions of the EU Foreign Affairs Council meetings of 15 August, 20 October, 17 November and 12 December 2014 and 16 March 2015 on the Ebola crisis in West Africa,
– having regard to the reports to the European Council drawn up in November 2014 and March 2015 by Christos Stylianides, Commissioner and EU Ebola Coordinator,
– having regard to the Comprehensive Response Framework for the Ebola Virus Outbreak in Western Africa drawn up by the European External Action Service and the Commission,
– having regard to the Extractive Industries Transparency Initiative (EITI) and to the 2011 EITI progress report of Sierra Leone, the 2012 EITI progress report of Liberia and the 2012 EITI progress report of Guinea,
– having regard to the French RIPOST ‘Network of Public Health Institutes in West Africa’ programme,
– having regard to the resolution on the Ebola outbreak adopted by the ACP-EU Parliamentary Assembly on 3 December 2014 in Strasbourg, France,
– having regard to its resolution of 18 September 2014 on the EU’s response to the Ebola outbreak[1],
– having regard to Rule 52 of its Rules of Procedure,
– having regard to the report of the Committee on Development and the opinions of the Committee on the Environment, Public Health and Food Safety and the Committee on Women’s Rights and Gender Equality (A8-0281/2015),
A. whereas the health systems of Liberia, Sierra Leone and Guinea contain massive gaps, and whereas the three countries already before the outbreak were among those at the bottom of the UNDP’s human development index, with around 80 % of the countries’ citizens living in extreme poverty, and scored highest in the world in premature adult and under-five mortality rates, mainly for treatable conditions;
B. whereas the Ebola crisis is systemic at local and regional level and also at national and global governance level;
C. whereas the magnitude of the catastrophe can be attributed to several factors, among which: the political failure of the affected countries to sound the alarm, the ill-adapted response of the international community, the shattering effects of closure of borders and restrictions on people, the ineffectiveness of the surveillance and alert mechanisms, the slow and poorly adapted response once aid was eventually mobilised, the stark absence of leadership from the WHO, the lack of research and development of drugs, diagnostics and vaccines;
D. whereas still too little is known about the prevalence, transmission and mutation potential of the Ebola virus; whereas widespread confusion and prevailing misunderstandings about the causes and consequences of Ebola virus disease have perpetuated the spread of the virus; whereas ethnographic research is useful in order to understand how communities work and how to reach people with different cultural backgrounds;
E. whereas Ebola virus disease was found in semen and in ocular fluid of convalescent persons; whereas there are single evident cases of sexual transmission, which indicates difficulties to eradicate the virus and to determine a point in time when countries really can be regarded as Ebola free;
F. whereas in a large number of African countries the health and education systems have deteriorated throughout the Structural Adjustment Programmes imposed by the IMF and World Bank, which required budget cuts in the public sector;
G. whereas the Ebola outbreak in West Africa has shown that local and national health systems in low-income countries do not have the means or resilience to respond to an infectious disease outbreak such as that of Ebola; whereas strengthening global health systems has therefore become an integral part of global health governance;
H. having regard to the importance of culture and traditional customs in the management of the Ebola crisis[2];
I. whereas children, adolescent girls and young women are among the most marginalised and vulnerable during such a crisis, which poses a serious threat to women’s engagement in economic activities and has increased gender gaps in education; whereas orphans may face repudiation and stigmatisation;
J. whereas the Ebola epidemic which affected West Africa is the largest and most complex outbreak in the history of the disease; whereas the WHO was first alerted to the outbreak of Ebola on 23 March 2014, but whereas it was only on 8 August that the International Health Regulations Emergency Committee declared it a public health emergency of international concern; whereas prior to this outbreak, Ebola had not been considered a major public health challenge;
K. whereas nearly 500 healthcare workers have died of Ebola in Guinea, Liberia and Sierra Leone, in countries suffering already from a serious shortfall of staff before the outbreak of the Ebola crisis; whereas hospitals and health staff did not have the capacity to deal with other diseases owing to the resources mobilised to fight the Ebola epidemic; whereas there is a need to protect health facilities and health workers to enable the sustainable provisions of medical care;
L. whereas many recovered patients have had to face stigmatisation from both their relatives and society; whereas this situation particularly affects children who have lost one or two parents, and many of these children have been rejected by their surviving relatives for fear of infection;
M. whereas there is a need to integrate epidemiology, public health and social science in order to draw appropriate lessons from the Ebola outbreak;
N. whereas in the first few months of the Ebola crisis, the humanitarian NGOs – Médecins Sans Frontières and the Red Cross in particular – were the most effective, best informed and most experienced players and therefore played a front-line role in initial efforts to combat the virus;
O. whereas the closing of schools and the tendency for orphaned children to become caregivers in households risk creating a ‘lost generation’ of children deprived of formal education for long periods of time;
P. whereas with their know-how and their ability to work together, the humanitarian organisations showed that, when it is necessary at the start of a crisis, they can be more relevant and more effective than the ‘institutional players’;
Q. whereas the Ebola crisis has resulted in another problem which Médecins Sans Frontières has referred to as ‘a crisis within a crisis’, namely that people with conditions other than Ebola are not going to hospital for fear that they will be infected with the virus;
R. whereas the EU, together with its Member States, is the biggest donor of development aid in the world and has made available more than EUR 1.39 billion to help contain the outbreak of Ebola virus disease in West Africa; whereas this amount enables the EU to negotiate with partner countries and other donors to support a comprehensive national health system development that builds on a coherent, inclusive, needs-based strategy;
S. whereas the United Nations World Food Programme has proved that it has an effective logistics capability that could be used in future for early warning and response purposes as well;
T. whereas the safety of caregivers is essential for the international mobilisation of health workers;
U. whereas the European Council appointed an EU Ebola Coordinator on 23 October 2014 in the person of the Commissioner for Humanitarian Aid and Crisis Management, Mr Stylianides; whereas since 12 November 2014 he has visited the countries most affected, accompanied by the Commissioner for Health, Mr Andriukaitis;
V. whereas the United Nations, the WHO and the Commission have established procedures for assessing the management of the epidemic;
W. whereas in a statement issued in April 2015 the WHO acknowledged that the world and the organisation itself were poorly prepared to deal with a lengthy epidemic;
X. whereas it is essential to improve international governance of health crises;
Y. whereas access to medicines is a key part of the right to health;
Z. whereas 2 billion people worldwide do not have access to the vaccines or treatments they need to stay alive and healthy;
AA. whereas access to medicines and to research and development findings in this area must be geared, as a priority, to the needs of sufferers, whether in Europe or in developing countries;
AB. whereas Innovative Medicines Initiative is the world’s biggest public-private partnership in life sciences, with a budget of EUR 3.3 billion for the 2014-2024 period, of which EUR 1.638 billion comes from Horizon 2020;
AC. whereas the trauma of Ebola has left people distrustful of health facilities, left health workers fearful of resuming services and left communities impoverished and suspicious; whereas the basic relaunching of health services is urgent; and whereas it is equally essential to set up robust and effective health systems, including mutualisation of risks, in all developing countries, which also implies solid training of the local medical staff;
AD. whereas the Ebola crisis has dragged the countries in the area affected deeper into recession, and whereas in 2015 alone, according to the World Bank, the GDP of the three countries worst affected will be reduced by USD 2 billion as a result;
AE. whereas those three countries have applied to the IMF and the World Bank for a ‘Marshall Plan’ package worth EUR 7 500 million, to help them to overcome their economic difficulties;
AF. whereas some NGOs have called on the World Bank to raise some USD 1.7 billion in order to help those countries to make lasting improvements to their healthcare infrastructure;
AG. whereas the international community needs to remain vigilant, and whereas the goal is to reach the post-Ebola stage, i.e. the stage at which there have been no new cases of infection for a long period;
AH. whereas good hygiene practices are indispensable; whereas, however, the three countries lack sufficiently working water and sanitation systems;
AI. whereas it is to be feared that in the case of any other outbreak, the scale of the death toll would reoccur;
AJ. whereas Vice-President / High Representative Federica Mogherini, European Commissioner for Humanitarian Aid and EU Ebola Coordinator Christos Stylianides, European Commissioner for International Cooperation and Development Neven Mimica, Members of the European Parliament, governments and parliamentarians of the Member States have repeatedly called for the strengthening of health systems;
AK. whereas, under the 11th European Development Fund, health system strengthening and the strengthening of water and sanitation services are only among the focal sectors for Guinea, and not for Liberia and Sierra Leone;
AL. whereas the Commission communication on the EU Role in Global Health (COM(2010)0128) presents a comprehensive and holistic needs-based global health strategy that was endorsed by the Member States;
AM. whereas not all states fully implemented the IHR; whereas the IHR should be revised after gaining experience during the latest Ebola epidemic;
AN. whereas little is known about potentially dangerous zoonoses; whereas food and agricultural practices, deforestation and trade in animals and animal products led to the emergence of newly evolving zoonotic diseases such as avian influenza, Ebola and HIV;
AO. whereas the WHO recommends coordination between public health and veterinary sectors;
AP. whereas a delegation from the Committee on Development will visit Sierra Leone in November 2015;
1. Criticises the slow international response to the crisis during the first months; stresses, however, the response and commitment of the EU and its Member States since March 2014 to help contain the propagation of the Ebola virus; notes the scaling-up of the EU and its Member States’ commitment in the areas of humanitarian and development aid, logistics and research to respond to the crisis;
2. Welcomes the development of a new vaccine (in record time), which has proven 100 % effective in Guinea as of 23 March 2015, and calls for urgent guaranteed access to this vaccine, which should be affordable to everyone in Liberia and Sierra Leone;
3. Calls on all parties concerned, particularly governments of developing countries, European institutions and international organisations, to learn from this crisis, including from the negative impacts on health sectors in developing countries of the conditionalities of IMF and World Bank structural adjustment facilities, and to develop effective means of dealing with international health crises;
4. Notes, in this context, the reform announced by the Director of the WHO on 18 May 2015, particularly as regards the establishment of a new emergency programme and a world reserve of staff who can be deployed quickly on the ground, and the establishment of a new reserve fund of USD 100 million specifically for emergencies; welcomes the commitment to increase the WHO’s budget by 10 % within two years, bringing it to USD 4.5 billion;
5. Calls on the international community to promote information and education campaigns in the countries concerned; stresses the crucial importance of prevention and information campaigns in managing the crisis, in particular in order to limit contamination, and to raise awareness of unsafe practices that should be avoided; stresses the importance of alternative means of disseminating information;
6. Strongly emphasises the importance of combating increased tensions between groups as a result of the Ebola outbreak, as the creation of myths could mean that certain ethnic groups are blamed for the Ebola outbreak;
7. Takes the view that, once emergency assistance is no longer required, the EU’s long-term response should focus first on development assistance, which will need to include investment in the health sector to promote resilience, particularly as regards the organisation and management of health systems, health monitoring and information, medicine supply systems, domestic governance and state-building, and then focus on the assistance that is essential in order to get the three countries’ economies back on their feet;
8. Calls on the authorities to take into account the lessons learnt concerning the stigmatisation phenomenon and to implement them in similar humanitarian crisis which may occur;
9. Recalls the importance of conflict prevention, as conflicts and fragility have a very negative impact on health systems;
10. Calls for the establishment of a permanent European rapid response capability comprising experts, laboratory support staff, epidemiologists and logistics facilities, including mobile laboratories, that can be deployed extremely swiftly; draws attention in particular to the contribution the EU can make to screening at land and maritime borders and to the fact that the Union could seek to emulate and benefit from the level of excellence achieved by the US health authorities in screening at airports;
11. Calls also on the EU to support the establishment of a network of monitoring points in developing countries to make it possible to detect as quickly as possible new cases of infectious disease which have the potential to develop into pandemics, in order to create a sentinel network in those countries;
12. Recognises the need to support the establishment of cooperation between the EU and its Member States and developing countries, in particular those of West Africa, as far as training medical staff is concerned;
13. Stresses the importance of strengthening protection and rapid evacuation systems for international health workers;
14. Deplores the fact that past adjustments and reforms and inequitable development policies have contributed to ineffective health systems; urges the Commission to help the three countries affected to develop their own public health systems in order for them to be able to meet basic healthcare needs and to build up the infrastructure required to ensure that all their citizens have access to public healthcare; in particular, takes the view that building a resilient health system over the long term requires, inter alia, (i) investing resources in basic public health services, (ii) ensuring safe and quality care by increasing resources to train, supervise and pay health workers adequately and by giving access to safe drugs, (iii) engaging local stakeholders and communities in crisis response and development planning; calls on international donors to increase Official Development Assistance (ODA) to those countries through country systems such as budget support; calls on the Commission to establish, in cooperation with partner countries, the WHO, the World Bank and other donors, coherent needs-based health plans and monitoring procedures;
15. Stresses that the responses should address the underlying gaps in women’s representation, access to health and services and the disruption to livelihoods; stresses in particular the need to offer high-quality basic services and healthcare, especially where maternity care and obstetric and gynaecological services are concerned;
16. Welcomes the Commission communication on the EU Role in Global Health (COM(2010)0128) and its holistic vision on comprehensive health systems, its horizontal approach and its endeavour for universal health coverage; encourages the Commission to review this communication in the light of new insights gained during the Ebola crisis, while keeping the comprehensive and horizontal approach, and to present and implement a Programme for Action in a timely manner;
17. Stresses, in general, the need for developing countries to give budgetary priority to setting up robust and resilient public social security and public health systems, building sufficient numbers of well-equipped, sustainable healthcare infrastructure (in particular laboratories, water and sanitation facilities) and offering high-quality basic services and healthcare; emphasises the need for a sufficient ratio of health workers to population, and calls on the governments of the affected countries to ensure that health workers are paid and that money for health reaches the people; acknowledges, nevertheless, that crises such as the current one cannot be solved by health systems alone, and that a comprehensive approach involving different sectors such as education and training, sanitation, food safety and drinking water, is needed to address the critical gaps in all essential services; stresses, at the same time, that education, covering cultural dimensions and beliefs, are also key in the recovery;
18. Points out that investment in the health sector is an important driver of economic development and contributes to poverty reduction in developing countries; welcomes the inclusion of Goal 3 ‘Ensure healthy lives and promote well-being for all at all ages’ in the proposal for future Sustainable Development Goals (SDGs);
19. Stresses that the long-term costed plans needed to build resilient and comprehensive health systems must further include an adequate number of trained health workers, access to sufficient medical supplies and robust health information systems;
20. Calls for research infrastructure to be bolstered by the establishment of a regional public infectious disease research centre in West Africa, and for inter-university cooperation to be established with the participation of the EU and its Member States;
21. Stresses the need to tackle social inequality in order to build a resilient, sustainable public health system; supports, to this end, the introduction of publicly funded universal health coverage free at the point of use, and urges the Commission, together with partner countries and other donors, to submit as soon as possible a programme for establishing universal health cover, which will guarantee the mutualisation of health risks;
22. Calls on all countries to commit to Universal Health Coverage (UHC) and to develop a plan identifying domestic resources and potential international funding to meet this goal; supports the target of scaling-up healthcare spending in all countries to the recognised minimum of USD 86 per person for essential health services;
23. Welcomes the high-level international conference on Ebola held on 3 March 2015 under the auspices of the EU and key partners with the aim of eradicating Ebola but also of assessing the impacts on the affected countries in order to make sure that development aid builds on humanitarian efforts;
24. Supports the idea of a ‘Marshall Plan’ to help kick-start those countries’ economies; suggests offering technical assistance to the administration to enhance their capacity and to ensure that money reaches the people and is not lost to corruption or other purposes;
25. Welcomes international efforts to alleviate the international debt burden of the countries affected by the Ebola virus;
26. Believes that partnerships between the EU and the area affected by the crisis will be effective only if Liberia, Guinea and Sierra Leone are able to take ownership of their own development as quickly as possible;
27. Believes that the programming of the 11th European Development Fund should be reviewed to ensure that investments in health and good governance become priority areas for all countries with fragile public infrastructure; is concerned that health and water and sanitation are not among the focal sectors in the National Indicative Programmes of Liberia and Sierra Leone; calls on the Commission to establish mechanisms to monitor aid more closely;
28. Believes that the risk posed by the structural under-funding of EU humanitarian action cannot be ignored during the mid-term review of the multiannual financial framework;
29. Congratulates the humanitarian aid workers and medical staff on the ground who have risked their lives in the efforts to contain this major health crisis;
30. Congratulates the United Nations Mission for Ebola Emergency Response (UNMEER), partner organisations and non-governmental humanitarian organisations, such as Médecins Sans Frontières, the International Federation of Red Cross and Red Crescent Societies, Emergency and others, for their work done on the ground, and warmly welcomes their extensive input and help in controlling this outbreak; regrets the cases of inappropriate treatment of medical staff and other staff involved in the fight against the Ebola outbreak following their return from Africa;
31. Believes that access to medicines should, as a matter of principle, no longer be dependent on patients’ purchasing power but should instead be geared to patients’ needs, and that market forces should not be the sole determinant of which medicines to produce;
32. Calls for the EU and its Member States to honour the EU’s ‘Policy Coherence for Development’ principle, set out in Article 208 TFEU though the promotion of fair and equitable international trade, medical research and innovation policies that foster and facilitate universal access to medicines;
33. Calls on the Commission to explore alternative models to those based on patent monopolies when it comes to the development of drugs or vaccines produced by public-private partnerships, such as the Innovative Medicines Initiative, which can guarantee patient accessibility to treatments, sustainability of healthcare budgets and an efficient response to crises such as the one caused by the Ebola virus or similar threats;
34. Stresses the importance of increasing global epidemiological research capacity, developing ‘quick tests’ and providing access to vaccines; welcomes, in this regard, the fact that many EU research funds have been mobilised to fight against the Ebola virus, including through the Innovative Medicines Initiative, the Horizon 2020 programme and the European & Developing Countries Clinical Trial Partnership (EDCTP) programme; underlines that, although vaccines are welcome, they are most probably not suitable to eradicate Ebola, as the virus is mutating; stresses, therefore, that funding priority has to be given to general health system strengthening, hygiene, containment, reliable quick testing in tropical settings and medication targeting the virus and the symptoms it causes;
35. Urges all parties concerned to promote health training among the public by focusing on the issue of traditional customs that are incompatible with the fight against the spread of the disease among the population;
36. Stresses that the EU should promote effective and fair financing of research that benefits the health of all and ensures that innovations and interventions lead to affordable and accessible solutions; reiterates, in particular, that models that dissociate the costs of research and development and the prices of medicines should be explored, including the opportunities for technology transfer to developing countries;
37. Reiterates the need to invest in neglected diseases; calls, in this context, on the Commission to continue the discussions on this issue and to make arrangements for wide-ranging cooperation between the public and private sectors, provided that safeguards are introduced to prevent public-private partnerships from harming vulnerable people in an unregulated market, aiming at reinforcing national health systems and facilitating the transfer of results to the population concerned; welcomes in this regard the fact that, to address the urgent need for research into new treatments, the EU has made available EUR 138 million for projects developing clinical trials for new vaccines, rapid diagnostic tests and treatments under Horizon 2020 and the Innovative Medicines Initiative; commends the European pharmaceutical industry, which has also committed important resources to supporting the research efforts;
38. Underlines that Ebola and other epidemics are transnational threats that call for international cooperation; calls on the WHO to revise the IHR with a view to incorporating interdependent responsibility and financial support, including for addressing root causes;
39. Welcomes, in the light of sketchy IHR implementation and a lack of epidemiological surveillance, the French RIPOST ‘Network of Public Health Institutes in West Africa’ programme;
40. Stresses that now that the outbreak is in decline, while the virus stays in the gonads for months after recovery, sexual counselling and family planning has to be made available as part of the health system and education measures;
41. Stresses that a food crisis seems increasingly likely to follow in the wake of the epidemic, which has devastated small-scale farmers; calls on the Member States, the Commission and the international community to invest in their long-term development in order to ensure that farming households and West Africa’s future food security do not remain at risk;
42. Calls on its relevant committee to monitor the crisis management measures being taken, in close cooperation with the EU Ebola Coordinator, and after Parliament’s mission to Sierra Leone, before submitting a final assessment based on well-defined criteria;
43. Instructs its President to forward this resolution to the Council, the Commission, the Vice-President of the Commission / High Representative of the Union for Foreign Affairs and Security Policy, the governments and parliaments of the Member States, the governments and parliaments of the African Union countries, the Secretary-General of the United Nations and the World Health Organisation.
- [1] Texts adopted, P8_TA(2014)0026.
- [2] Customs which, for example, prohibit the burning of dead bodies.
EXPLANATORY STATEMENT
Since March 2014, Sierra Leone, Liberia and Guinea have been in the grip of the worst ever Ebola crisis. Diseases do not stop at borders, and so the Ebola virus spread very quickly from one country to another. The three countries involved are among those at the bottom of the UNDP’s human development index: average life expectancy is 60 or under; schooling rarely extends beyond three years; and around 80% of the countries’ citizens live in extreme poverty.
These indicators show that the people of Sierra Leone, Liberia and Guinea are in an extremely vulnerable situation, and it is clear that the three countries cannot get through it on their own. The scale and complexity of the current Ebola epidemic pose a real challenge for Sierra Leone, Liberia and Guinea, whose health and education systems have shortcomings that are structural in nature. The Ebola crisis is therefore systemic at local, regional and national level.
Ebola is also systemic at the level of global governance, and the international community’s response was therefore too long in coming.
Things only really got going in September 2014. In making Mr Stylianides – the new humanitarian aid Commissioner – the EU’s Ebola coordinator, the European Council sent a clear message to the Member States and to the Commission. Improvising is no longer enough. It is worth pointing out at this juncture that the legal basis for Mr Stylianides’ task is now enshrined in the Lisbon Treaty.
The mandate of the Commissioner for humanitarian aid is extremely broad and is a real test for all those involved in European efforts in the areas of research, innovation, crisis management, deploying medical personnel on the ground and setting up an evacuation system, as well as in longer-term efforts in the area of development cooperation.
The European Parliament, as always, has made it clear that its task here is to scrutinise the executive, to take on its role as legislator, and lastly to provide a political impetus. For Parliament’s Committee on Development, the EU – the world leader on development – has a special responsibility when it comes to promoting the right to universal healthcare. We can insist that the EU should press ahead with its efforts, so that others can follow its example. The EU’s voice must be heard, particularly in this, the year of development, under the slogan ‘Our world, our dignity, our future’.
In the fight against Ebola, therefore, the EU must respond to the following challenges and key issues.
What is its relationship with the WHO, whose job it is to provide information about the development of an epidemic in its initial stages? The WHO, which provides guidelines for scientists, is after all expected to take action with a view to coming up with a vaccine and medicines to treat Ebola.
Is the WHO in a position to provide the transport and logistics capabilities that are vital in order to stop the epidemic? The USA, for example, was able to deploy thousands of troops and a significant amount of equipment in record time in the area affected by Ebola.
The Ebola crisis has also resulted in another problem – something which, in one of its appeals, Médecins Sans Frontières has referred to as ‘a crisis within a crisis’. Many people with conditions other than Ebola are not going to hospital for fear that they will be infected with the virus. The EU is expected to try to find a solution to this problem, in close cooperation with its African partners.
And furthermore, should we not be helping the countries in Africa to develop their own research capabilities?
Politics, too, has a role to play in research. The proponents of the right to universal healthcare quite rightly remind us that it is not for the market to set the priorities for research. So what initiatives does the EU need to take in this area, both at EU level and within international fora?
As the rapporteur, I firmly believe that in the first few months of the Ebola crisis, the humanitarian NGOs – Médecins Sans Frontières and the Red Cross in particular – were the most effective and best informed players, and those that were the most capable when it came to playing a front-line role in the fight against the virus, the consequences of which, as we are all aware, have been so terrible. With their indisputable amounts of knowledge and know-how, as well as their abilities to provide information and to work together, the humanitarian organisations showed that, when it is necessary at the start of a crisis, they can be relevant and more effective than the ‘institutional players’. I believe that we need to start discussing the ways in which the best use can be made of the humanitarian organisations’ capabilities in the future. This does not, of course, mean calling their status or fundamental principles into question. Just because it is an extremely delicate question does not mean it should not be asked.
We should now also start thinking about the post-Ebola period. The post-Ebola stage will have been reached once there have been no more new cases for 42 days. Once this happens, the EU’s response will need to be twofold: first, development aid will need to include investment in health, and second, it will be vital for the three countries to receive aid with a view to kick-starting their economies. Before the crisis, annual GDP growth expectations for the three countries were on average well above 5%. However, with Ebola having substantially slowed down economic activity, the three countries are now in recession. The earlier the three economies are able to mobilise enough resources, the better it will be in terms of the countries’ autonomy and their ability to provide funds to meet vital health requirements.
Partnerships between the EU and the area affected by the crisis will be effective only if Liberia, Guinea and Sierra Leone can to take ownership of their own development as quickly as possible. The programming of the European Development Fund for the three countries will have to be reviewed to take account of the numerous challenges brought about by the Ebola crisis. It is also important to make it clear at this point that the mid-term review of the multiannual financial framework will no longer be able to ignore the risk posed by the structural under-funding of EU humanitarian action.
To conclude, we hope that all those involved will demonstrate the vision they need to enable them to assume their responsibilities in the period that follows, even though Ebola faded from the news headlines a long while ago.
The Ebola crisis has both highlighted the structural problems that are still to be found in a number of countries and served as a reminder to EU leaders of the need for them to stay true to their goal of allocating at least 20% of official assistance on the development of basic social services, giving priority to healthcare.
OPINION of the Committee on the Environment, Public Health and Food Safety (27.3.2015)
for the Committee on Development
on the Ebola crisis: the long-term lessons and how to strengthen health systems in developing countries to prevent future crises
(2014/2204(INI))
Rapporteur: Josu Juaristi Abaunz
SUGGESTIONS
The Committee on the Environment, Public Health and Food Safety calls on the Committee on Development, as the committee responsible, to incorporate the following suggestions into its motion for a resolution:
A. whereas the Ebola outbreak in West Africa in 2014 is the largest and most complex outbreak of this virus in history, affecting many countries, and has resulted in thousands falling ill and dying[1]; whereas the World Health Organisation (WHO) was first alerted to the current outbreak of Ebola on 23 March 2014, but it was not until 8 August that the International Health Regulations Emergency Committee declared it a public health emergency of international concern; whereas prior to this outbreak, Ebola had not been considered a major public health challenge;
B. whereas a total of 150 new confirmed cases of Ebola virus disease (EVD) were reported in the week ending 15 March 2015; whereas there were 95 new confirmed cases reported in Guinea in that week – the highest weekly total for the country in 2015, and Sierra Leone reported 55 new confirmed cases over the same period – the country’s lowest weekly total since late June 2014; whereas Liberia reported no new confirmed cases for the third consecutive week;
C. whereas the outbreak has affected more than 20 000 people, mainly in Guinea, Liberia and Sierra Leone, and has spread from Africa to two other continents with isolated cases; whereas the countries worst hit by the current outbreak of Ebola in West Africa are countries with particularly under-resourced, under-staffed and vulnerable health systems; whereas the escalation of the Ebola epidemic has caused not only a medical crisis claiming thousands of lives but also social and economic pressures and political instability in the affected countries and wider regions;
D. whereas this epidemic is unpredictably and constantly evolving owing to the lack of isolation facilities and skilled medical workers, while foreign medical workers have difficulties in winning the trust of the populations concerned; whereas international support has to address all key aspects of the epidemic, from community education and mobilisation, improving the quality and strength of health systems, training of personnel and medical supportive care, to coordinated epidemiological control, tracing and surveillance in order to effectively control the outbreak; recalls that the introduction of a case into an unaffected country remains a risk for as long as cases are reported in any country;
E. whereas the main challenges in the three most affected countries have been the lack of experience in dealing with Ebola, a highly mobile population, a widespread public misperception of the disease and its transmission paths and a high degree of community resistance to early treatment, leading to acts of aggression against international medical personnel;
F. whereas the quality and strength of health systems have been key to effectively controlling the outbreak;
G. whereas the impact of the Ebola crisis exceeds its mortality rates, affecting the political stability and the prosperity of the economies of the affected regions, including threats to regional food security and social cohesion; whereas according to the World Bank, in 2015 alone, the impact on the GDP of the three most affected countries will be USD 2 billion, as a direct consequence of the crisis;
H. whereas in February 2015, the WHO reported for the first time that year an increase in weekly infection rates in the three countries with high transmission levels, Guinea, Liberia, and Sierra Leone, where the response to Ebola is still a major challenge;
I. whereas the international community underestimated the scale of the outbreak and the initial response was therefore hesitant, focusing primarily on financing or building Ebola case-management structures, leaving it up to national authorities, local healthcare staff and NGOs to supply the necessary resources in terms of medical staff;
J. whereas the European Union has deployed financial assistance worth EUR 1.1 billion from more than 434 European Commission funds; whereas the WHO has recently called for three measures to eradicate Ebola completely: an extra fund of USD 1 billion (EUR 800 million), better coordination and management of emergency situations and ensuring the access of new medicines to the market;
K. whereas the European Commission has been actively engaged from the very start of the outbreak, has been scaling up its response to the epidemic and monitors the situation through its Emergency Response Coordination Centre, which serves to coordinate EU assistance under the authority of the EU Ebola Coordinator, Christos Stylianides;
L. whereas EVD eradication faces significant challenges such as the beginning of the wet season, increasing geographical spread, widespread transmission, continued community resistance and unsafe burials;
M. whereas the activation of the EU Civil Protection Mechanism has facilitated rapid, coordinated deployment of emergency supplies and experts offered by the Member States;
N. whereas, across the region, there are still no adequate facilities in the locations required for isolating and diagnosing patients; whereas in many places in West Africa, the coordination, geographical distribution and flexibility of these facilities still represent a major challenge;
O. whereas, according to UNICEF, several thousand children have been orphaned as a result of the epidemic; whereas many Ebola victims suffer from discrimination, loss of status and social exclusion;
P. whereas the Ebola epidemic has highlighted serious shortcomings in local health crisis prevention; whereas the international community’s response to the countries affected by Ebola should include different elements, such as laboratory capacity to diagnose and confirm infection, awareness-raising, improving the commitment of the community and cultural comprehension, social mobilisation, contact tracing and monitoring, alerts and surveillance, access to health care for non-Ebola patients and ensuring safe funerals; whereas the protection of both health facilities, which are still lacking in parts of West Africa, and health workers, who play a key role in such emergency circumstances, should be developed through an emergency medical training programme to overcome the acute shortage of local medical staff and to contain the epidemic;
Q. whereas the Commission has launched, through the Innovative Medicines Initiative (IMI), eight projects working on vaccine and diagnostics, run under the new Ebola+ programme with a total budget of EUR 215 million; recalls that EUR 114 million come from Horizon 2020, and the remaining EUR 101 million from the pharmaceutical companies involved in the projects; whereas additional funds are still needed to help countries introduce vaccines, rebuild the collapsed health systems and restore immunisation services in the countries affected by Ebola; whereas the results of clinical trials for Ebola vaccines should be available in the first quarter of 2015, while in the meantime, two vaccine candidates currently being tested in humans have been shown to be both safe and efficacious in animals;
R. whereas the outbreak has dramatically affected local health personnel and the continuation of the training process in West Africa; whereas medical staff are still at great risk of becoming infected with Ebola;
S. whereas the measures taken in the fight against Ebola should form part of a coordinated process, ensuring greater transparency and clarity and focusing more on shortcomings and meeting needs;
T. whereas targeting international aid solely towards the Ebola virus and not towards building up local capacity to run efficient healthcare systems may produce pernicious effects, for example an upsurge in the incidence of other diseases, such as diarrhoeal diseases which cause child deaths, and malaria, as a result of a let up in efforts to prevent and treat them;
U. whereas the impact of the death rates in affected countries is further worsened by struggling health systems which are unable to provide basic services such as immunisation, childcare and maternal health services;
1. Deplores the loss of lives in the region devastated by the Ebola outbreak and expresses its sincere condolences to the governments of the countries and to the people directly and indirectly affected by the outbreak;
2. Welcomes the establishment of the UN Mission for Ebola Emergency Response (UNMEER) and of the EU Task Force for Ebola, the appointment of Commissioner Christos Stylianides as EU Ebola Response Coordinator, and the overall contribution and help of numerous partner organisations, specialised national and international agencies, the Funds, national and international non-governmental organisations, local and international medical staff and the volunteers working on the ground to combat Ebola;
3. Notes the progress and contributions made at international and European level, but stresses that there is still a considerable amount of work that needs to be done to help countries contain and eradicate the Ebola epidemic; reiterates the importance of a European strategy to coordinate the Ebola response at Union level and to enhance the state of preparedness and protection within the Union itself;
4. Requires the Member States, the Commission and the international community to coordinate and strengthen medical research and the production of effective medicines and vaccines against Ebola and other emerging diseases that are otherwise neglected by the pharmaceutical commercial sector, taking care to ensure that these trials take place under ethical conditions whereby patients give informed consent prior to taking part, and there is transparency concerning clinical data stemming from this research and genuine access, where possible free of charge, to these vaccines and treatment for the populations targeted (skilled staff and suitable facilities for administration of treatment, prices not to exceed the real cost of production); regrets the fact, however, that grant agreements for the Ebola+ projects will be signed after the release of the IMI funds and not beforehand, and expects pharmaceutical companies involved to adhere to and respect corporate social responsibility principles, specifically by means of affordability of the innovative vaccine treatment;
5. Welcomes the eight research projects carried out by the EU under the Ebola + Innovative Medicines Initiative with the aim of developing vaccines and rapid diagnostic tests;
6. Points out that the international community should learn from self-criticism on late response, taking into consideration the specific features of this outbreak; stresses the need to continue supporting institutions such as the WHO, which has proven to be essential at international level for coordinating and boosting public health related issues;
7. Welcomes the Commission’s mobilisation of EUR 24.4 million in 2014 and EUR 114 million in 2015 from Horizon 2020 to fund research projects that combat Ebola through the development of vaccines, rapid diagnostics tests and clinical trials to test existing and new Ebola compound treatments;
8. Welcomes the fact that in January 2015 the first trial of a potential drug to treat Ebola started at a Médecins Sans Frontières centre in Liberia and that vaccine trials, which would normally take decades, are now being fast-tracked in Ebola-affected countries on a timescale of weeks and months;
9. Considers that the initial response of the Member States and the Commission was hesitant and did not reflect the true extent of the crisis; welcomes and encourages in this regard the ongoing scaling-up of the Commission’s and Member States’ financial commitment in the areas of humanitarian and development aid, logistics and research to respond to the crisis; points out, however, that it is necessary to ensure the access of innovative medicines to the market, and the access of medical teams, qualified health workers, laboratories, epidemiologists and protective equipment, among others, to Ebola-affected areas;
10. Calls on the EU to keep the leadership in fighting the EVD outbreak; stresses that although the efforts invested in containing the outbreak showed significant results, it is necessary to eradicate the disease; welcomes, in this regard, the high-level international conference on Ebola on 3 March 2015, organised by the EU and key partners with the aim of eradicating Ebola but also to assess the impacts on the affected countries in order to make sure that development aid will build upon humanitarian efforts;
11. Calls on the Commission to put in place rigorous control systems to ensure that the entire budget allocated to improving healthcare and sanitation infrastructure, making it possible to tackle general health inequalities while combating the Ebola outbreak and preventing further health crises, is actually used to fight the epidemic in the countries affected by the virus and not for other purposes;
12. Considers it necessary to monitor adequately whether the budget allocated is distributed in a transparent and readily understandable manner and truly addressed to the affected countries;
13. Stresses that the current crisis poses a threat to the weak economy and to political and social stability, not only in the countries affected but also throughout the West African region; emphasises that improving health systems will not be enough to eradicate Ebola; takes the view that a concerted and long-term approach involving international, national and regional actors and the various sectors (healthcare, education and training, sanitation, hygiene, disinfection, food aid, drinking water, functioning sewerage systems, waste disposal, economy) is needed to address the critical gaps in all essential services; stresses that education covering the cultural dimension and beliefs of these countries, and addressing the current Ebola outbreak in a complete way, including the appropriate dissemination of clear information, is essential in finding a fully comprehensive solution to the problem; recalls its commitments to dedicate 20 % of funds available under the development cooperation instrument to health services;
14. Expresses concern at the fact that information on Ebola and the spread of the disease is not reaching everyone owing to low levels of literacy; emphasises the importance of alternative ways of disseminating information, such as providing more information via the radio; notes that there is mistrust of the authorities in the affected areas and emphasises how important it is that essential healthcare is also provided in rural areas;
15. Stresses that a food crisis seems increasingly likely to follow in the wake of the epidemic, which has devastated small-scale farmers; calls on the Member States, the Commission and the international community to invest in their long-term development in order to ensure that farming households and West Africa’s future food security do not remain at risk;
16. Acknowledges that to reach zero cases, every person who had high-risk contact with someone with Ebola needs to be identified; points out that traceability and monitoring of contacts are two of the main challenges confronting us and recalls that quarantine-related measures require special support to those affected, such as providing food, water or medical care;
17. Stresses the importance of the EU avoiding a ‘one size fits all’ approach when providing crisis assistance in developing countries, in particular by paying attention to sub-national health systems by increasing the qualified health workforce; calls on the international community and the EU to lead the work on building resilient health systems, through national plans that will be used as the basis on which all international actors and partners can define roles and responsibilities, and to work together with the countries affected to develop an emergency medical training programme with a view to overcoming the acute local shortage of medical staff and to ensure that measures are taken on the ground to immunise the population;
18. Stresses the importance of learning from the Ebola crisis and the need to better coordinate and strengthen the health systems in the Member States as well;
19. Calls on the international community to take the steps required to address the social problems caused by the outbreak and, in particular, to ensure that children orphaned by Ebola are protected and cared for and that Ebola victims are integrated into society;
20. Congratulates the United Nations Mission for Ebola Emergency Response (UNMEER), partner organisations and non-governmental humanitarian organisations, such as Médecins Sans Frontières, the International Federation of Red Cross and Red Crescent Societies, Emergency and others, for their work done on the ground and warmly welcomes their extensive input and help in controlling this outbreak; regrets the cases of inappropriate treatment of medical staff and other staff involved in the fight against the Ebola outbreak following their return from Africa;
21. Calls on the Member States and the Commission to offer financial support to the families of members of the organisations mentioned in paragraph 20 (UNMEER, partner organisations and non-governmental humanitarian organisations, such as Médecins Sans Frontières) who have died in the fight against Ebola and from its effects;
22. Calls on the Member States to ensure that medical staff have the right to all necessary medical treatment should they become infected and, as a matter of course, medical evacuation to their countries of origin if, as is the case of the EU Member States, they have the necessary Ebola treatment facilities;
23. Calls on the Member States, the Commission and the international community to continue strengthening the health systems in the West African countries affected; stresses that Ebola is definitely a disease with a high mortality rate, but that there are other fatal diseases (such as malaria) in the area that should be treated as well; emphasises how important it is that the EU invests in and encourages capacity building in the field in order to meet the requirements of the International Health Regulations and to address the problem of the weak health systems, which have left people in many parts of West Africa without access to basic healthcare, so that local staff may be provided with the training and adequate resources to face future epidemics (Ebola or any other illness); stresses that protecting medical staff involved in fighting the outbreak is of the greatest importance and emphasises how important it is that the latest Ebola outbreak should not be seen as an isolated case, but as a sign that long-term investment is needed to combat the virus;
24. Calls for educational and informative actions to be taken to raise awareness of symptoms and preventive measures in order to facilitate trust and popular cooperation with anti-Ebola measures, as information and communication constitute an important aspect of the fight against the Ebola outbreak; points out that the situation created in some Member States following the arrival of possible cases of Ebola has shown that a campaign of information and more effective communication is needed in Europe;
25. Stresses that, in the countries affected, orphans who have lost their families to the Ebola virus must be cared for by means of placement in orphanages and counselling;
26. Strongly emphasises the importance of combating increased tensions between groups as a result of the Ebola outbreak, as the creation of myths could mean that certain ethnic groups are blamed for the Ebola outbreak; also expresses concern about the extremely vulnerable situation of children, as children whose parents have died are seen as carriers of the disease and are isolated from society and forced to live alone on the streets;
27. Considers that the Member States as well as the EU institutions should assess the opportunity of creating a health professionals’ database of trained emergency specialists to be deployed in a timely manner, and assist developing countries in strengthening their public health systems;
28. Encourages taking immediate action to create a financial environment for research into the prevention of further outbreaks, and to coordinate and strengthen medical research and the production of effective medicines, clinical tests and policies, not only against Ebola but also against certain other epidemic-prone, life-threatening infectious diseases that cause a high number of deaths in Africa, and to publish the data regarding vaccine safety and effectiveness; stresses the necessity of not withdrawing from research efforts, given the need for continuous control of the epidemic, taking care to secure ethical conditions for the trials by means of informed prior consent of the patients who take part in the trials, transparency in the clinical data resulting from this research and effective access to these vaccines and treatments by the populations concerned (qualified staff and adequate infrastructure for care delivery, with the price not exceeding the real cost of production); expects the grant agreements of the Ebola+ programme to be made public with regard to their conditions and award procedures;
29. Calls on the Member States to make further efforts to provide the EU Emergency Response Coordination Centre with the resources and staff it needs; urges the Member States to coordinate their efforts in the Health Security Committee, with the involvement of the Commission, and emphasises the importance of further cooperation and exchanges of information on the pool of EU aid volunteers, which aims to provide an effective European response to disasters;
30. Calls on the international community to guarantee that there are sufficient supplies of personal protective equipment available and to take measures to guarantee safe medical evacuation of international staff in the future;
31. Welcomes, in that connection, the mobilisation of medical evacuation capacities (Medevac) for international humanitarian aid workers who have contracted the disease in the course of their work in the countries affected;
32. Requires all actors involved in the response to take a much more flexible approach and allocate resources according to:
– the most pressing local needs at any given time and place, taking into account the long-term objective of eradicating Ebola and preventing future outbreaks;
– the need to prepare a transition towards a sustainable post-crisis situation that is favourable to peace;
stresses that remote rural areas should benefit from more international support;
33. Is concerned at the manner in which the Ebola outbreak is also weakening women’s livelihoods, owing to the considerable decline in small-scale farming and trade since the outbreak of the virus, exposing women to an even higher risk of infection; also notes the role of women in preparations for burials and stresses the importance of protecting against infection without threatening cultural structures;
34. Calls for measures to be implemented once Ebola has been suppressed to restore faith in the security of affected countries in order to bring back investors and initiate an economic recovery, which is one of the preconditions for preventing epidemics in the future;
35. Requests that the Commission, once this outbreak is under control, come forward with a report drawing on the lessons from the West African Ebola outbreak, highlighting potential areas of improvement in future EU responses to similar health crises;
36. Urges all actors involved in the crisis to consider the opportunities that new technologies have to offer in delivering improved speed of response.
RESULT OF FINAL VOTE IN COMMITTEE
|
Date adopted |
26.3.2015 |
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|
|
|
|
Result of final vote |
+: –: 0: |
66 0 0 |
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Members present for the final vote |
Marco Affronte, Margrete Auken, Zoltán Balczó, Catherine Bearder, Ivo Belet, Simona Bonafè, Biljana Borzan, Nessa Childers, Alberto Cirio, Birgit Collin-Langen, Miriam Dalli, Seb Dance, Angélique Delahaye, Ian Duncan, Stefan Eck, Bas Eickhout, Eleonora Evi, José Inácio Faria, Karl-Heinz Florenz, Iratxe García Pérez, Elisabetta Gardini, Jens Gieseke, Sylvie Goddyn, Matthias Groote, Andrzej Grzyb, Jytte Guteland, György Hölvényi, Anneli Jäätteenmäki, Jean-François Jalkh, Benedek Jávor, Karin Kadenbach, Kateřina Konečná, Giovanni La Via, Peter Liese, Norbert Lins, Valentinas Mazuronis, Susanne Melior, Massimo Paolucci, Gilles Pargneaux, Piernicola Pedicini, Bolesław G. Piecha, Pavel Poc, Annie Schreijer-Pierik, Renate Sommer, Dubravka Šuica, Tibor Szanyi, Nils Torvalds, Glenis Willmott, Jadwiga Wiśniewska, Damiano Zoffoli |
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Substitutes present for the final vote |
Soledad Cabezón Ruiz, Herbert Dorfmann, Linnéa Engström, Luke Ming Flanagan, Jan Huitema, Karol Karski, Merja Kyllönen, Anne-Marie Mineur, James Nicholson, Aldo Patriciello, Marit Paulsen, Bart Staes, Theodor Dumitru Stolojan, Tom Vandenkendelaere |
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Substitutes under Rule 200(2) present for the final vote |
Marie-Christine Boutonnet, Emilian Pavel |
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- [1] Situation report: http://www.who.int/csr/disease/ebola/situation-reports/archive/en/
OPINION of the Committee on Women’s Rights and Gender Equality (4.3.2015)
for the Committee on Development
on the Ebola Crisis: the long-term lessons and how to strengthen health systems in developing countries to prevent future crises
(2014/2204(INI))
Rapporteur: Teresa Jiménez-Becerril Barrio
SUGGESTIONS
The Committee on Women’s Rights and Gender Equality calls on the Committee on Development, as the committee responsible, to incorporate the following suggestions into its motion for a resolution:
A. whereas its resolution of 18 September 2014[1] recognised that women are disproportionately affected by the Ebola virus disease (EVD), with women accounting for, on average, 55-75 % of all victims; whereas evidence suggests that pregnant women are hit particularly hard, with death tolls close to 100 % cent when infected, compounded by their vulnerability to and fear of infection through maternal health care;
B. whereas women are not only more likely to be infected, but their education, healthcare, food security and livelihood are also suffering as a consequence of the spread of the disease;
C. whereas women and girls are particularly exposed to EVD because of their roles as principal caregivers, as health workers dealing with childbirth, as maternal patients and as those handling corpses before burial rites; whereas women are also severely affected by loss of income as smallholder farmers, or as cross-border traders confronted by a decline in food and crop production; whereas women face steep increases in food prices, diminishing food security and closed borders, putting them behind in payments for microcredit loans and making it more difficult for them to feed their families;
D. whereas gender activists and women’s advocacy groups in the most affected countries have urged leaders to address the disproportionate effect of EVD on the female population;
E. whereas women dominate the informal economic sector, which has been hard hit;
F. whereas EVD frequently causes pregnant women to miscarry, since when an expectant mother falls ill, it is rare that she is able to continue with the pregnancy;
G. whereas there is a high risk that breast-feeding mothers will transmit the disease to their children, and whereas in such cases unwell mothers should be helped to make the transition to bottle feeding;
H. whereas obtaining treatment is problematic for pregnant women, owing to the invasive nature of that treatment;
I. whereas mother and child health has been protected in combatting EVD by polio workers assisting in the emergency response in Nigeria; whereas in Nigeria the Ebola virus was brought under control in part through replication of the emergency operation centres set up to fight polio;
J. whereas women in healthcare systems are not only vulnerable, but – reflecting the role they play in society – are also key actors in containing EVD, for example as nurses, cleaners or laundry workers in hospitals, and in raising awareness about EVD, planning responses to it and promoting prevention strategies in their communities;
K. whereas female nurses represent the majority of health staff who have been infected and died from the virus; whereas the humanitarian crisis has put a drain on healthcare facilities, equipment and personnel, drawing already scarce resources away from pregnant women; whereas the lack of access by women, especially pregnant women, to reproductive health services is a major health disaster in waiting[2];
L. whereas women are the primary care-givers at home and in the community in most African societies, and whereas it is sisters, daughters, aunts, mothers and grandmothers who have cared most for relatives infected with Ebola, putting themselves at great risk;
M. whereas widespread confusion and prevailing misunderstandings about the causes and consequences of EVD have perpetuated the spread of the virus;
N. whereas families who eat bushmeat, and hunters who touch infected wild animals or their blood, are rarely aware of the risks associated with processing and consuming such game;
O. whereas EVD is not only a public health catastrophe but also has long-lasting psychological, social and economic effects on women and girls in particular; whereas following the death of a relative, rumours and fear surrounding EVD for women and girls persists, e.g. when their inheritance rights or their role as orphans are broached, while the closing of schools and the tendency for orphaned girls to become caregivers in households risk creating a ‘lost generation’ of children deprived of formal education for long periods of time and increases the risk of teenage pregnancy, child marriage and violence against women;
P. whereas many female survivors experience difficulties in reintegrating themselves into their families and communities and may face repudiation and stigmatisation;
Q. whereas it is mostly women who perform the funeral rituals when their relatives die of EVD;
R. whereas women who are too afraid of contamination stop seeking medical care and family planning services;
S. whereas Ebola infections in Africa have been associated with the hunting, butchering and processing of bushmeat from infected wild animals such as bats and monkeys;
T. whereas EU emergency aid in response to the EVT pandemic could have been better, characterised as it was by the lack of rapid technical assistance on the ground, the unwillingness of Member States to cooperate and inadequate central EU coordination;
1. Acknowledges the role played by the international community in combatting EVD, and calls on it, in formulating further response strategies, to address the realities facing women and girls through targeted actions; underlines the importance of gender-balanced health specialist teams and the availability of sex-disaggregated data and research, and stresses the need to promote initiatives aimed at ensuring greater psychological and health support for women infected with the virus as a result of caring for patients;
2. Calls on the international community to promote information and education campaigns to make women aware of unsafe practices that should be avoided, and to spread accurate information that helps limit the risk of infection in a manner that does not interfere with local customs;
3. Stresses that the empowerment of women should involve women in designing projects and in local decision making, as building human capacity now, especially for women and girls, will help reconstruct their societies;
4. Believes that the negative effect – amplified in rural areas in particular – of disintegrating health systems on maternal health is of major concern, given the declining availability of beds, the lack of trained staff and the risk that (future) mothers will be hindered from going to hospitals when necessary, or will later refrain from doing so; emphasises, therefore, that such negative perceptions keep patients at home in the hands of female caregivers; insists on the need to invest in measures targeted at pregnant women, in order to provide them with adequate care and to build trust between female patients and caregivers; asks the Commission and the Member States to provide financial support for these efforts; calls on the Commission and the Member States to implement gender budgeting in all EU relevant funding, prioritising funding for women and children, and for sexual and reproductive health and rights;
5. Suggests that organisations working to combat the Ebola outbreak should employ various modes of communication – including community dialogue, and radio and television where available – to involve women in efforts to raise public awareness about the disease;
6. Stresses the need for innovative, mobile systems to guarantee care in urban and rural areas throughout the region, and calls for specific funding for the training and employment of nurses, community health workers and midwives by the EU;
7. Considers it essential that, when large-scale vaccination campaigns get under way, priority is given to women, as they are the primary victims and caregivers, and are often responsible for educating the children;
8. Supports the promotion of prophylactic treatments to prevent infection that focus on women in particular;
9. Considers it necessary that adequate resources are allocated as well to the fight against other types of disease of particular danger to pregnant women, such as malaria;
10. Stresses that clear and unambiguous responses are needed that acknowledge the role of women as key actors in protecting their families and communities and in breaking EVD transmission chains; stresses the need to stimulate recovery, including measures to: engage women’s organisations in schemes to provide information on the importance of health-care, such as sessions that address EVD-related precautions for women and girls; train EVD-survivors as nurses, cleaners and laundry workers; and ensure equal protection of all hospital staff; stresses as well the importance of providing men and women with detailed information about sexual and reproductive health, in particular the risks associated with sexual intercourse after recovery;
11. Encourages the government of the countries concerned to take the measures necessary to combat the stigmatisation and isolation of women and girls when a family member dies, and to ensure that their fundamental rights are protected, in particular inheritance rights and the right to education;
12. Emphasises the valuable and effective work carried out by international aid organisations, and the development of decentralised local project funding, which will ensure that women and girls in particular are given better access to available resources, and provide them with employment prospects in the region through decentralised training structures, while, at the same time, helping to stem the brain drain from the affected areas of medically trained personnel;
13. Remains deeply concerned about the heavy toll of EVD on women and girls, and underlines that failure to address gender-specific issues will have a negative impact on the prospects for long-term recovery, and on the level of equality between women and men in the affected countries; insists on the need to reintegrate female survivors into society, socially as well as financially, and emphasises the importance of promoting best health practices and awareness campaigns in the countries most affected by the virus; calls on the EU and the Member States to fund training programmes to help women become key actors in raising such awareness;
14. Underlines the need to recognise and address the gender dimensions of this type of sanitary crisis, both in the emergency response and in the longer-term reconstruction effort;
15. Urges public authorities to take into account the fact that gender dynamics could help save lives through, among other things, targeted messages to women about the importance of using protective measures in and outside the home;
16. Underlines the necessity of accurately depicting in the media the role of women, and the realities they face, in order to avoid that social customs are deliberately used to reinforce gender roles that have been, at least partly, at the origin of the disproportionately high infection rate among women;
17. Expresses its concern over the fact that information about EVD and its spread is not reaching everyone because of poor literacy; stresses the importance of alternative means of disseminating information, for example by providing more information over the radio; notes a degree of mistrust on the part of authorities in the affected area, and stresses the importance of providing essential medical treatment in rural areas as well;
18. Calls on the EU and the Member States to consider the urgent need to allocate resources to reinforce maternal healthcare systems, the long-term impact of health infrastructure rebuilding and the need for psychological support for those affected;
19. Calls on the Commission, and on researchers in the pharmaceuticals industry, not simply to concentrate research, and funding provided through Horizon 2020, on the needs of the wealthy regions of the world, but to bring the concerns of emerging nations into focus, giving particular attention to women, pregnant women and children, with the ultimate aim of being able to offer developing countries affordable medicines for the diseases that affect them;
20. Calls for the international community, including private companies, to address the current gap in empirical research, to investigate further the particular effects of EVD on the lives of women and girls and to develop a thorough understanding of the unique role of women in forming responses to these kinds of health crises;
21. Strongly emphasises the importance of combatting increased tension between groups as a result of the Ebola outbreak, as there is a risk that myths are spread that place the blame for the outbreak on certain ethnic groups; expresses as well its concern about the extremely vulnerable position of children, not least in light of the fact that children whose parents have died are seen as carriers of the disease and are isolated from society and forced to live alone on the streets;
22. Calls for the international community to address the severe economic and psychological cost of EVD for women, and to empower women so that they can care and provide for their now often extended families;
23. Is concerned about the fall in women’s means of subsistence following the considerable reduction in small-scale farming and trade since the outbreak of the virus, exposing women to an even higher risk of infection; notes as well women’s role in the preparation of burials, and stresses the importance of addressing the risk of infection associated with this in a way that does not threaten cultural structures.
RESULT OF FINAL VOTE IN COMMITTEE
|
Date adopted |
26.2.2015 |
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|
|
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Result of final vote |
+: –: 0: |
21 4 1 |
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Members present for the final vote |
Daniela Aiuto, Anna Maria Corazza Bildt, Viorica Dăncilă, Anna Hedh, Teresa Jiménez-Becerril Barrio, Elisabeth Köstinger, Vicky Maeijer, Angelika Mlinar, Krisztina Morvai, Maria Noichl, Marijana Petir, Liliana Rodrigues, Jordi Sebastià, Ernest Urtasun, Ángela Vallina, Beatrix von Storch, Jadwiga Wiśniewska, Anna Záborská |
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Substitutes present for the final vote |
Inés Ayala Sender, Linnéa Engström, Eleonora Forenza, Arne Gericke, Constance Le Grip, Dubravka Šuica, Marc Tarabella |
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Substitutes under Rule 200(2) present for the final vote |
José Inácio Faria |
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RESULT OF FINAL VOTE IN COMMITTEE RESPONSIBLE
|
Date adopted |
22.9.2015 |
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Result of final vote |
+: –: 0: |
25 1 0 |
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Members present for the final vote |
Louis Aliot, Beatriz Becerra Basterrechea, Ignazio Corrao, Nirj Deva, Doru-Claudian Frunzulică, Nathan Gill, Charles Goerens, Enrique Guerrero Salom, Heidi Hautala, Maria Heubuch, Teresa Jiménez-Becerril Barrio, Arne Lietz, Linda McAvan, Norbert Neuser, Maurice Ponga, Cristian Dan Preda, Lola Sánchez Caldentey, Elly Schlein, Davor Ivo Stier, Paavo Väyrynen, Bogdan Brunon Wenta, Rainer Wieland, Anna Záborská |
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Substitutes present for the final vote |
Eleni Theocharous |
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Substitutes under Rule 200(2) present for the final vote |
Liliana Rodrigues, Estefanía Torres Martínez |
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FINAL VOTE BY ROLL CALL IN COMMITTEE RESPONSIBLE
|
25 |
+ |
|
|
ALDE |
Beatriz Becerra Basterrechea, Charles Goerens, Paavo Väyrynen |
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ECR |
Nirj Deva |
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EFDD |
Ignazio Corrao |
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ENF |
Louis Aliot |
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GUE/NGL |
Lola Sánchez Caldentey, Estefanía Torres Martínez |
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PPE |
Teresa Jiménez-Becerril Barrio, Maurice Ponga, Cristian Dan Preda, Davor Ivo Stier, Eleni Theocharous, Bogdan Brunon Wenta, Rainer Wieland, Anna Záborská |
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S&D |
Doru-Claudian Frunzulică, Enrique Guerrero Salom, Arne Lietz, Linda McAvan, Norbert Neuser, Liliana Rodrigues, Elly Schlein |
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VERTS/ALE |
Heidi Hautala, Maria Heubuch |
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1 |
- |
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EFDD |
Nathan Gill |
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0 |
0 |
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Key to symbols:
+ : in favour
- : against
0 : abstention