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Reviews | Uganda’s Ebola outbreak is a test of what we’ve learned from Covid

KAMPALA, Uganda — Uganda’s first major Ebola outbreak occurred when I was a medical student at Makerere University in Kampala. A professor of virology explained to us the dangers of filoviruses, the family of viruses to which Ebola belongs, and why they must be avoided at all costs.

Seven years later, in 2007, I was a newly appointed military officer, tasked with responding to a new outbreak of Ebola near the border between Uganda and the Democratic Republic of Congo, where I saw this danger of first hand.

It’s one thing to learn about the virus in medical school, but it’s another to travel deep into a remote area to deal with a deadly scrouge. By the time we arrived, several health workers had already died. Local people believed witchcraft was involved, which led to a community witch hunt to find someone to blame for the deaths of their loved ones.

This outbreak marked a turning point in my medical career because I realized how complex the threat of Ebola could be. When I had wanted to become a surgeon, I decided to turn to the epidemiology of infectious diseases. I wanted to help respond to emerging infectious diseases in my country, which are both technological and trust challenges. Today, so soon after the spread of Covid across the country, Uganda is experiencing a new outbreak of Ebola, and we are once again confronted with the fragility of this balance.

People in Uganda, like everywhere else, have been suspicious since the start of the Covid-19 pandemic, and they fear further disruptions to their lives such as 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 enormous burden of rebuilding trust – a challenge that may seem daunting.

As Incident Commander at the Ministry of Health, I am responsible for leading the national response to Ebola, which includes coordinating a variety of experts and determining new response strategies.

In many ways, our ability to contain Ebola outbreaks has changed since the last major Ebola outbreak in West Africa. There are new technologies, including tests, treatments and vaccines. And whereas in the past we would have avoided invasive procedures for fear that they were too risky, today we know that early intravenous rehydration with fluids and early oxygen mask supplementation can significantly improve the outcomes of patients.

However, the Ebola outbreak we are facing in Uganda stems from the Sudanese species of the virus, for which there is 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 roll out soon. Although we don’t have rapid tests for this strain, we make do with mobile PCR testing labs that can deliver results in about four to six hours. With support from the United States government, we are using experimental monoclonal antibody treatments to treat infected healthcare workers, along with other treatments like remdesivir.

But many remain concerned about this Ebola outbreak. At present, there are around 131 confirmed cases and 46 deaths, including a few cases in Kampala, the capital. We know that the countermeasures available to us work best when administered at the earliest stage of this disease. Patients who have monoclonal antibodies late in their disease have died, for example. But most Ebola patients show up at public health facilities too late. Many went to private facilities or tried alternative methods first. We also need more treatments to treat the patients we see early.

Having the tools we need to respond quickly is important not only to save lives, but also to gain the trust of communities. The government announced a 21-day lockdown to help stem the spread of the virus, which may have helped prevent transmission but may also increase mistrust and frustrations. Recently, the body of a young person who died from the virus was exhumed so locals can rebury the body based on religious traditions. Although not a common occurrence, even a single incident like this can dramatically increase exposure to the virus and reverse the gains we have made.

Our ability to control this largely depends on our ability to show our people that we can protect them and that they follow our recommendations. It’s easier if we can react quickly and effectively. To do this, we need countries and systems where we can need help to hear our demands and act quickly.

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 quickly we can secure vaccines this time around, as getting quick access to vaccines during the early days of the Covid-19 pandemic was a challenge. But the world needs more holistic approaches to strengthening global health security, now and for the future.

As in every other country, Ugandan systems have been strained since the hit of Covid-19. I also led the response to Covid, where I witnessed a crushing collapse in confidence in public health interventions as people faced heavy travel restrictions and family disruption, loss of income and a disappearance of savings.

To recover what has been lost, health workers and responders in Uganda – and around the world – must be open with the public and consistent in our messaging. Today, people are more and more informed about epidemics and they are looking for information. We need to make sure people get quality messages, especially amid the misinformation and confusion spreading on social media. We also need to show the global public that we can protect them and their families.

Today there is an epidemic in Uganda. Tomorrow it could be somewhere else. After the last major Ebola outbreak in West Africa, the world started to make changes to make sure it didn’t happen again, but then moved on. Despite the contingency planning that was put in place after the last Ebola outbreak, the world saw how weak our response systems were in the midst of Covid-19. We have to finish the job this time.

Henry Kyobe Bosa is an epidemiologist, researcher and National Ebola Incident Manager for the Ugandan Ministry of Health.

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