January 11, 2023

Lurching from crisis to crisis: A reflection of ‘neglect’ and Ebola in Uganda

Lurching from crisis to crisis: A reflection of ‘neglect’ and Ebola in Uganda

Ebola Uganda

Source: Flickr (UNMEER)

Written by: Sharifah Sekalala

On 21 December 2022, the president of the Republic of Uganda, Yoweri Kaguta Museveni, declared Uganda Ebola free, because it hadn’t reported a new case for 42 days – the criterion set by the World Health Organisation (WHO). Although the Ugandan Ebola crisis had, since 20 September, infected 142 people, 55 confirmed dead, including 8 school children and 7 health workers, the ‘end’ of the crisis didn’t even make many international headlines. It is true that these numbers are relatively small, but monkey pox which garnered huge global headlines killed only 22 people.

The paradox of perpetual crisis and neglect in global health

Uganda has faced five previous Ebola crises (2000-2001, 2007-2008, 2011, 2012-2013, 2018-2020). Patient zero for the 2022 crisis was a young man with the Sudan variant which had no known vaccine. Before 2016, when a mass outbreak in West Africa spread to many European countries, Ebola crises were primarily ignored by the international community. In the aftermath of the 2016 crisis, Joao Nunes used the term neglect to refer to diseases such as Ebola which are only recognised as a threat when they spread to life in the global north.

At the crux of this neglect is the way in which global health law recognises crises. In order to meet the WHO’s threshold for a Public Health Emergency of International Concern (PHEIC), a disease must cross borders. Therefore, countries like Uganda, which have managed to contain numerous public health crises within their borders, are often ignored.

Reaching the threshold of a PHEIC not only garners international attention but also allows developing countries to access funding, such as pandemic bonds. In the wake of the COVID-19 crisis, when the World Bank initially refused to pay, Bangin Brim and Clare Wenham accused the World Bank’s financing facility of being focused on paying out to investors over countries in need and creating a threshold in which the only realistic way in which poor countries can claim from this fund is if diseases spread across national borders.

Additionally, as Patricia Kingori has argued, the language of crises is framed within narratives with a singular beginning and end, which ignores the fact that some countries and communities remain in perpetual health crisis. This framing of crises that have a singular beginning and end neglects the experiences of huge parts of the world whose crises are becoming more frequent and more complex as zoonotic diseases spread from animals to humans, diseases mutate and spread faster due to globalisation but also due to increased environmental impacts from climate change in many parts of the world.

The crisis of care amidst depleted systems

The Ebola crisis in Uganda was also a crisis within broader social economic crises. The country was still struggling with the 2020 COVID-19 crisis, with only 13 million people out of 50 million people fully vaccinated, other infectious diseases, such as malaria, tuberculosis and HIV on the rise, and an economic crises caused by a prolonged period of lockdown.

Health workers were particularly affected with them forming 26 percent of infections. Yet again, the Ebola Crisis in Uganda resuscitated old debates about the adequacy of Personal Protective Equipment (PPE) for frontline workers. Frontline workers also accused the government of failing to pay them appropriately. 17 percent of all those infected were children which led to early school closures, with schools being closed two weeks early. This had a huge impact, as children in Uganda had already been subjected to the longest period of school closures in the world.

Countries that are perpetually in crisis rely on families for care, especially women. In Uganda, women are often the main caregivers in their homes, communities, and health facilities, which puts them at higher risk of illness. Rai et al. use the term ‘depletion’ to refer to the way in which the human energy needed for caring is hard to replenish. Low- and Middle-Income Countries like Uganda face depletion during crises, not only of frontline workers but also of women who continue to care when systems such as schools can no longer continue.

Vaccines and global neglect

Although Ebola was discovered more than 19 years ago, the vaccines that had been developed for the previous Ebola crisis were not effective on the Sudan Strain. The ways in which vaccines are researched, produced and distributed has come under increasing scrutiny, with rich countries being accused of vaccine colonialism, because although many countries took part in vaccine trials, once they were produced, rich countries hoarded vaccine doses, leaving many countries in the global south without access.

The proposed vaccine trials for the new Sudan variant highlights these global inequalities. Although the WHO lauded the fact that it took only 79 days to deliver trial vaccines, the vaccine trial which cost 9 million dollars has now been put on hold. As the prestigious journal Science had observed, ‘Uganda’s disappearing Ebola outbreak challenges vaccine testing.’ Because Uganda had done so well containing the Ebola outbreak, the waning number of cases made it difficult to create a ring trial, which is only effective if given to contacts of known cases.

The absence of a vaccine for the Sudan strain raises broader questions about the research and production of vaccines for diseases that are neglected. Although the trial included Ugandan scientists, the trial vaccines were produced in the global north, and the international community needed to raise US$9 million for a disease that has been endemic in Sub-Saharan Africa. This leaves the entire global community still vulnerable to a disease for which we may have had a cure if were not for neglect.

Author Bio

Sharifah Sekalala is a Professor of Global Health Law at the University of Warwick. Prof Sekalala is primarily interested in global health crises and the impact of law in curbing inequalities. Her research is focused primarily on Sub Saharan Africa and she is currently PI on a Wellcome-Trust-funded project on digital health apps in Sub-Saharan Africa. Prof Sekalala also serves as an Associate Fellow of Chatham House’s Global Health Program and the Chair of the Human Rights Working Group of the Global Health Law Consortium. This piece was made possible by funding from the Connaught Foundation Grant No: 512634 and Warwick Law School’s Impact Fund.

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