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Montefiore in the News

October 4, 2022

The East African nation’s health system has been weakened by the coronavirus pandemic and budget cuts

A grave was prepared for an Ebola victim in Mubende, a district about 90 miles from the capital that is at the center of the outbreak.PHOTO: HAJARAH NALWADDA/ASSOCIATED PRESS

KAMPALA, Uganda—Uganda’s health system, already weakened by the coronavirus pandemic and budget cuts, is struggling to contain an Ebola outbreak caused by a strain for which there are no proven vaccines or antiviral treatments and which can’t be detected by rapid tests.

Two weeks after Ugandan authorities first announced that a 24-year-old man had died of the relatively rare Sudan strain of Ebola, there are now 43 confirmed cases, including nine deaths. Nineteen other people who either lived in or had visited the young man’s village are also believed to have died from the virus as far back as early August, but were never tested. 

This means the outbreak, now spread across five farming districts in central Uganda, likely started more than a month before it was detected, raising fears that there are more unknown cases. The center of the outbreak lies along a major highway connecting Uganda’s capital, Kampala, with the Democratic Republic of Congo. It is around 20 miles from Kibale National Park, popular with foreign tourists coming to see Uganda’s chimpanzees.

The Ebola isolation section at a regional hospital in Mubende that lacks facilities to carry out PCR tests to detect the virus.PHOTO: HAJARAH NALWADDA/ASSOCIATED PRESS

Congo, Kenya, Rwanda and South Sudan have started screening travelers crossing their borders with Uganda for Ebola symptoms, which include fever, vomiting, headaches and fatigue. Asymptomatic Ebola patients usually can’t pass on the virus, but because of its long incubation period—up to 21 days—an infected person can travel far from the epicenter of an outbreak before falling ill.

New tools that have transformed the fight against Ebola in recent years—including antiviral treatments and vaccines used to inoculate a patients’ contacts to contain spread—don’t work against the Sudan strain of the virus. Most outbreaks in recent years, including the 2014-16 epidemic that killed more than 11,000 people across West Africa, were caused by the Zaire strain of Ebola.

Rapid tests that are used to quickly diagnose patients showing Ebola symptoms also can’t pick up the Sudan strain, which means samples need to be shipped 110 miles to the only laboratory in the country equipped to detect the strain through polymerase chain reaction, or PCR, tests, a spokesman for the Health Ministry said. Results can take up to two days to get back. 

“This is another wake-up call for the international community,” said Kartik Chandran, a virologist at the New York City-based Albert Einstein College of Medicine, who has spent years researching treatment strategies for Ebola. “The medical community has to keep working on vaccines and therapeutics that work on multiple strains, not just a single strain, ready for the next outbreak.”

The World Health Organization and the Africa Centers for Disease Control and Prevention have pointed to Uganda’s record of quickly containing Ebola outbreaks, including before vaccines were approved. Four flare-ups since 2011, including in 2019, when a single imported case from Congo was isolated before it could spread, never developed into wider outbreaks.

But Ugandan doctors and some health officials say they worry that the coronavirus pandemic and budget cuts have weakened the country’s health system. Many village health teams that are usually on the lookout for Ebola and other contagious diseases have stopped working after the government said it lacked the funds to raise members’ monthly salaries of around $2.50 to $25 as promised three years ago.

Trainee doctors at the main Ebola treatment center have gone on strike, saying they haven’t been given adequate protective gear. Uganda’s health minister, Jane Aceng, told health workers at the center that the government couldn’t afford to pay them special Ebola allowances until donors have provided at least $18 million in funding to respond to the outbreak over the next three months. A doctor and a midwife have already died from the virus and at least five other healthcare workers have been infected.

“You cannot compare the allowances you’re asking for with a life,” Dr. Aceng said over the weekend. “Let us save lives, money will come later.”

A Uganda Red Cross Society medical officer instructing people with Ebola symptoms to enter an ambulance near the town of Mubende on Thursday.PHOTO: HAJARAH

The WHO, Africa CDC and Doctors Without Borders have sent staff and medical supplies. Ugandan officials said they are in talks with different drugmakers on candidate vaccines that may work against the Sudan strain.

Still, several frightened patients fled the main treatment center in late September after health workers took their samples for testing, said Rosemary Byabasaija, who heads a government task force battling Ebola in the affected region. One of the samples tested positive but the patient it came from hasn’t been located.

Authorities have now deployed armed guards outside the hospital, where some 24 patients are currently admitted. More than 800 contacts of known cases are sheltered in several makeshift treatment-and-isolation centers.

An Ebola virus awareness campaign poster in the Ugandan capital Kampala.PHOTO: STRINGER/SHUTTERSTOCK

“There is a lot of misinformation about health facilities,” said Dr. Byabasaija. “Our target now is to educate the community so that they understand the disease better.”

The Ugandan economy is reeling from the disruptions of the pandemic, drought and rising inflation. Last month, the central bank lowered the economy’s growth prospects to 2.5% from a previous estimate of 4.5%. The Finance Ministry cut the Health Ministry’s budget by 5%, or around $30 million, this year, according to data from the Ugandan Parliament.

“This is a disease that has a very high fatality rate,” said Samuel Oledo, president of the Ugandan Medical Association. “Government should find the resources and provide the facilities that health workers rightly deserve.”