Truman National Security Project

In July 2012, the Ugandan Ministry of Health (MOH) informed the World Health Organization (WHO) of an outbreak of Ebola hemorrhagic fever in the western district of Kibaale. As of 8 August, Uganda’s MOH had reported 23 probable cases (including 10 laboratory confirmed) leading to 16 deaths, and dozens of people who had been in contact with these cases remained under close observation even as the outbreak appeared to slow. This particular outbreak initially proved difficult to detect because many of the cases presented with severe diarrhea, muscle pain, and fever, but did not exhibit the telltale external bleeding typically associated with Ebola virus.

The outbreak caused alarm not only in Uganda but in neighboring states, as local newspapers reported first that a Kenyan man exhibiting Ebola-like symptoms had travelled by bus from South Sudan through Uganda and on to Kenya for treatment at a hospital in Eldoret, and subsequently that a potentially infected mother and child had fled from Uganda into Tanzania.  Health officials in these countries had already stepped up surveillance efforts, and quickly isolated the suspect cases and their contacts until they could rule out Ebola.

Uganda is no stranger to highly infectious disease outbreaks.  The devastating 2000 Ebola outbreak in Uganda resulted in 425 reported cases, half of which were fatal. The Uganda MOH has taken prompt action to control the most recent outbreak, mobilizing field response efforts and surveillance activities in the districts surrounding Kibaale and beyond. WHO and other partners, including the U.S. Centers for Disease Control and Prevention (CDC),  African Field Epidemiology Network, Infectious Diseases Institute, Uganda Red Cross Society, Médecins Sans Frontières, and local NGOs, supported MOH responses, from conducting public awareness campaigns to building an isolation facility in Kibaale to laboratory testing at the Uganda Virus Research Institute (UVRI).   Because of previous disease outbreaks, the Ugandan government recognized the importance of building national capacities to detect and respond to public health crises and developing international cooperation. This recent Ebola outbreak has highlighted the progress made as well as the benefits of good working relationships with local and international partners.

Uganda is one of 194 States Parties that signed on agreed to the International Health Regulations (IHR [2005]), a legally binding commitment among nations to  build the core capacities needed to detect, assess, report, and respond to public health events likely to have cross-border impact, and to share that information with WHO in a timely and transparent way. The Ugandan MOH mobilized rapid response teams to help conduct the epidemiological investigation — teams that were primed to handle this new outbreak in part because of the plans and capabilities developed under the IHR (2005) framework.

Under the IHR (2005), countries must take steps to develop their own core capacities for disease detection, laboratory confirmation, and effective response, a long-term effort that must be sustained continuously.  Uganda has been building these capacities since 2000 under the Integrated Disease Surveillance and Response strategy, adopted by the Member States of WHO Regional Committee for Africa (WHO AFRO) and adapted for use at the national level. With support from international partners such as WHO, CDC, and USAID, the government of Uganda developed resources and training for routine disease surveillance as well as epidemic response. Capacities for both improved measurably between 2000 and 2008. Over the same period, government funding for the MOH Epidemiology Surveillance Division declined 10-fold, leaving national health officials and their partners scrambling to maintain momentum.

Health Security Challenges

An outbreak of Ebola, regardless of its location, causes public alarm. Besides controlling the outbreak and determining the source of infection, one of the major challenges facing MOH is informing the public and addressing unwarranted anxiety, while helping affected households and communities cope. WHO has reported that this outbreak is under control. Nevertheless, it is still very scary to the population—whether in Uganda, neighboring nations, or countries thousands of miles away. Today’s highly globalized lifestyle dissolves the illusion of protective barriers (i.e. national borders) between communities around the world and this exotic but not-so-faraway disease.

Thus far, Uganda and its partners have responded quickly and effectively to contain the Ebola outbreak before it crossed international borders, a notable achievement. Under the frameworks of IDSR and IHR (2005) and through regional organizations, MOH had already established reliable communications with neighboring country counterparts and local and international partner organizations that could be leveraged for quick action.

These elements reflect the benefits of Uganda’s long-term strategy to build capacity in the health sector.  They also serve as a reminder of the ongoing need for stakeholders, including international partners, to continue to invest and assist in building capacity and coordinating response efforts.

Rebecca Katz is a Truman Security Fellow.

(Editor’s note: this post originally appeared on George Washington University’s IHR 2005 blog).