the fire last time

What we need to do about Uganda's Ebola outbreak should have happened years ago

Only by investing in the health systems of poor countries we can protect the world from deadly outbreaks
What we need to do about Uganda's Ebola outbreak should have happened years ago
Photo: James Akena (Reuters)
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The Ebola outbreak in Uganda is growing quickly. According to the World Health Organization (WHO), at least 63 cases, probable or confirmed, were recorded in about two weeks, which has resulted in 29 likely deaths (the Ugandan ministry of health has confirmed 10 deaths and is reviewing the rest). In only a few days, the case count has already made it among the biggest Ebola outbreaks in history.

There are no vaccines or treatments for the rare Sudan strain of virus, which is causing the outbreak. An experimental vaccine trial will be introduced soon, and until then treatment is limited to public health prevention measures—such as education about how to avoid contagion and monitoring the spread in the country and neighboring ones—and assisting patients with hydration and targeting symptoms.

Further, the Ugandan health system—which already faced severe shortages of resources and personnel—was further tested by covid, and has limited capacity to tackle the outbreak and protect its health workers. Several who have treated Ebola patients in the past few days have already died.

True to the familiar international health crisis script, the US has announced that it will screen all incoming travelers who have been to Uganda in the past 21 days for Ebola. The UK, too, is watching the situation, though it still considers it low-risk and is not screening travelers.

Ebola is easier to contain than covid. Infection requires contact with an infected person’s blood or bodily fluids, and it isn’t airborne. Yet the fact that the first line of response from the US was to introduce screenings—that is, to merely keep Ebola outside its borders—is an indicator that a mentality of emergency intervention still drives global health interventions. Which is exactly what has left Uganda ill-equipped to deal with the virus.

The limitations of emergency intervention

Almost a decade ago, in 2014, the deadliest Ebola outbreak recorded began in west Africa, in Guinea, Liberia, and Sierra Leone. It continued until 2018, killing more than 11,000 people. After a few cases were recorded in the US, among health workers traveling from the areas where the virus was spreading, the White House—then led by Barack Obama—developed an Ebola response plan. A czar was named. More than $6 billion was requested from Congress to support the countries fighting the outbreak, as well as prepare against health threats at home. The administration later developed a pandemic preparedness plan.

Arguably the most important point in the plan Obama presented to Congress in asking for funding against Ebola promised to “strengthen global health security by reducing risks to Americans by enhancing capacity for vulnerable countries to prevent disease outbreaks, detect them early, and swiftly respond before they become epidemics that threaten our national security.”

Global health experts have long been calling for this. But the cycle of emergency response followed by oblivion, followed by emergency, is hard to break, and despite the good intentions, funding barely continues for systemic interventions after crises end.

There is no safe containment strategy

Poverty doesn’t cause viruses, but it helps them spread in more ways than one, including by depriving health systems of resources. This is why the commitment to support poorer countries health systems is fundamental to avoid future crises. But this is the type of intervention that needs to be carried on after the immediate crises has ended, when the extra funding can be allocated toward infrastructure, personnel, training.

Weak health systems in poorer countries are not equipped to deal with severe outbreaks, which is tragic for them, and dangerous for the rest of the world. As we have seen with covid, zika, and monkeypox, there is no safety in trying to contain a virus in one country, or geographic area. As long as outbreaks are ongoing somewhere in the world, they can essentially spread anywhere.

Even before former US president Donald Trump dismantled the pandemic preparedness plan, the US had to divert the resources it had set aside to support west Africa against Ebola to put out the Zika fire. Despite White House insistence, the original fund for Ebola was not backfilled. Other rich countries don’t have the resources of the US, but many also fell short of their commitments to support local health systems outside their own borders. The United Nations goal of strengthening poor countries’ capacity to handle health is far from reach.

The current Ebola epidemic might warrant new emergency measures and interventions. But it should call for health investments in the region (beyond the specific areas where this crisis is occurring) regardless of how the spread progresses. Controlling a crises is not as good as avoiding it altogether, and only investments made independently from emergency response can actually do the job of protecting more vulnerable countries—in order to protect the stronger ones, too.