The first major Ebola outbreak in Uganda happened when I was a medical student at Makerere University in Kampala. A professor of virology explained to us the dangers of filoviruses, the virus family Ebola belongs to, and why they should be avoided at all costs.
Seven years later, in 2007, I was a newly minted military officer, detailed to respond to a new Ebola outbreak near the border of Uganda and the Democratic Republic of Congo, where I saw this danger firsthand.
It’s one thing to learn about the virus in medical school, but it’s another to travel deep into a remote area to face a deadly scourge. By the time we arrived, several health workers had already died. The local population had believed witchcraft was involved, leading to a community witch hunt for someone to blame for the deaths of their loved ones.
That outbreak was a turning point in my medical career because I realized just how complex a threat Ebola can be. Though I had wanted to become a surgeon, I decided I would switch to infectious disease epidemiology. I wanted to help respond to emerging infectious diseases in my country, which are challenges of both technology and trust. Today, so soon after the Covid spread through the country, Uganda is experiencing another outbreak of Ebola, and once again we are faced with how delicate this balance is.
People in Uganda, as in everywhere else, are wary since the start of the Covid-19 pandemic, and they dread further interruptions to their lives like lockdowns, travel bans or airport closures. Yet in a modern world where we are all connected, these kinds of efforts are sometimes necessary to respond to pandemic threats. That’s why public health workers here have the huge burden of rebuilding trust — a challenge that can feel immense.
As incident commander at the Ministry of Health, I am tasked with leading the national response to Ebola, which includes coordinating a variety of experts and determining new strategies for how to respond.
In many ways, our ability to contain Ebola outbreaks has changed since the last major Ebola outbreak in West Africa. There’s new technology, including tests, treatments and vaccines. And while in the past we would have avoided invasive procedures out of fear they were too risky, today we know that early intravenous rehydration with fluids and early oxygen mask supplementation can significantly improve patients’ outcomes.
However, the Ebola outbreak we are dealing with in Uganda is from the Sudan species of the virus, for which there’s no approved vaccine or treatment. We are doing what we can with experimental options, and there are vaccines in clinical trials that we hope to deploy soon. Even though we don’t have rapid tests for this strain, we are making do with mobile P.C.R. test laboratories that can give results in about four to six hours. With the support of the United States government, we are using experimental monoclonal antibody treatments to treat infected health care workers, as well as other treatments like remdesivir.
But much remains concerning about this Ebola outbreak. Right now, there are about 131 confirmed cases and 46 deaths, including a few cases in Kampala, the capital. We know that the countermeasures we have work best when they are given in the earliest stage of this disease. Patients who have monoclonal antibodies late into their illness have died, for example. But most Ebola patients are going to public health facilities too late. Many have gone to private facilities or have tried alternative methods first. We also need more of a supply of treatments to treat the patients we do see early.
Having the tools, we need to respond rapidly is important not only for saving lives but also to gain trust among communities. There was a 21-day lockdown announced by the government to help stem the spread of the virus, which may have helped prevent transmission but can also increase distrust and frustrations. Recently the body of a young person who died from the virus was exhumed so that locals could rebury the body based on religious traditions. While this is not a common occurrence, even a single incident like this can greatly increase exposure to the virus and reverse gains we’ve made.
Our ability to control this depends in large part on our ability to show our people that we can protect them, and on their following our recommendations in kind. This is easier if we can respond quickly and effectively. To do that, we need countries and systems we may need to lean on for help to hear our requests and act expeditiously.
Initiatives and groups like the Coalition for Epidemic Preparedness Innovations, a nonprofit that funds vaccine development to prevent pandemics, and the World Health Organization are helping us get early access to vaccines. This outbreak is a test of how much faster we can secure vaccines this time around, since getting fast access to vaccines during the early days of the Covid-19 pandemic was a challenge. But the world needs more holistic approaches to strengthen global health security, for this moment and for the future.
As in every other country, Uganda’s systems have been strained since Covid-19 hit. I led the response to Covid as well, where I witnessed an overwhelming meltdown in trust of public health interventions as people underwent burdensome travel restrictions and family disruptions, loss of incomes and disappearance of savings.
To regain what’s been lost, health workers and responders in Uganda — and around the world — need to be open with the public and consistent in our messaging. Today people are increasingly knowledgeable about outbreaks, and they seek information. We must make sure people are getting quality messaging, especially amid misinformation and confusion spreading on social media. We also must show the global public that we can protect them and their families.
Today there’s an outbreak in Uganda. Tomorrow it can be somewhere else. After the last major Ebola outbreak in West Africa, the world began to undertake changes to ensure it wouldn’t happen again, but then moved on. Despite the contingency planning that went into place after the last Ebola outbreak, the world saw how weak our response systems were amid Covid-19. We need to finish the job this time.
Henry Kyobe Bosa
Dr. Bosa is the national incident manager for Ebola for Uganda’s Ministry of Health.
