"When communities are empowered, they do miracles! When they understand exactly what the problem is, they educate each other, carry out surveillance, and they inform the responders in real time."
At the beginning of this year on 11th of January 2023, Uganda declared Ebola free in Mubende district after battling the Sudan Ebola Virus outbreak (EVD) for nearly 4 months. According to the Ministry of Health's last EVD report, the outbreak claimed the lives of 55 people and infected over 114 people in 9 districts which also disrupted the socio-economy of the affected communities. The report also shows that more than 87 people have recovered among the confirmed cases.
Africa CDC had an exclusive interview with the Minister of Health of the Republic of Uganda, Honourable Dr. Jane Ruth Aceng, about the recent Ebola outbreak experience.
Q. Could you please give us some background about the recent Sudan Ebola virus outbreak in Uganda?
A: Uganda discovered Ebola Sudan in Mubende District in the month of September 2022, which came as a shock, but also it found us relatively prepared. The outbreak occurred in an area with several caves and some minerals mines where in the past many investigations have been carried out regarding Marburg Virus. Having had an Ebola outbreak in Chebale, the same area where Ebola occurred previously. So, it wasn't a fresh area but of course, we are still interested to know where the Sudan Ebola Virus originated from.
- Given that Uganda has so far experienced several EVD outbreaks, please share how the response efforts and experience has strengthened Uganda's public health system.
A: Uganda has experienced seven Ebola outbreaks since the year 2000, when our first Ebola outbreak was extremely devastating, with over 400 cases and 250 deaths. Uganda started putting systems in place for early detection and response. Subsequently, we expanded laboratory capacity to the extent that we have several mobile laboratories that we can deploy anywhere at any time.
We also started the Field Epidemiology Training Program (FETP) program, and Laboratory training program at that time, to increase the number of field epidemiologists who could investigate and act as rapid response teams in the event of an outbreak. We also addressed the sample transport network because samples come from any part of the country. In addition, we developed a village health team surveillance manual and trained our village health team so they're on a lot at any one time.
We further commissioned the emergency operation centres where we can view activities in any district at any one time and receive alerts in real-time.
- What effective approaches did Uganda apply in managing the EVD outbreak?
A: One is community ownership, community engagement, and community surveillance. When communities are empowered, they do miracles!
Number two, when you have laboratories at the epicentre, then it is very easy to quickly detect who is positive and who is negative. So it makes the response much easier. Number three is the response teams that should be highly trained and ready to respond in real-time.
Number four (4) partnerships and collaborations because partners come in with resources, not only financial resources but also technical resources and knowledge that can contribute to controlling epidemics in real-time.
- What best practices can other Member States learn from Uganda's public health system in containing the EVD outbreak quickly?
A: Number one, time is of essence. Time matters! The time of reporting, the time of detection, and the time of declaration. Because when all this is done in real time, and when I talk about real time, I mean within 24 hours, then you know that you will get the contacts easily and can respond easily. Number two is to ensure that you declare the outbreak so that the international community and your own communities are aware that there is a danger in the country that needs to be responded to.
Number three, it is extremely important to ensure that you contain the outbreak where it has occurred.
And to contain it means you have to sensitise the populations, sensitise the country, and let them understand why you are implementing certain interventions to avoid exporting the virus.
And, of course, it is important to ensure that the village health teams or the communities are well-trained for them to move door to door. Of course, teamwork is extremely important, using the pillars that WHO has clearly outlined with proper coordination.
One of the other best practices that I implore all the other countries to adopt is the Accountability Forum, where we come together as the country in leadership with all the partners to give accountability for our actions on the ground and our resources mobilised.
- It is to be recalled that Uganda co-hosted the Ebola Emergency Ministerial meeting in Kampala in October 2022 in collaboration with Africa CDC and WHO. What is the most significant achievement of this Ministerial Meeting?
A: This meeting discussed, among other things, transparency, collaboration, sharing of information in a timely manner and sharing expertise. The result of this meeting was a communique, or I can say, a working document where we all 9 countries signed in agreement that when we get any outbreak within Africa, we will work together to ensure cross-border collaboration and coordination. That we don't export, we control at source, and we share information to get the other countries as much prepared as possible. A task force was also established, the Africa Ebola Coordination Taskforce (AfECT).
- Africa CDC supported the response efforts in strengthening various proven strategies for the prevention and control of Sudan Ebola Virus outbreak. How do you describe the impact and timeliness of this support?
A: Well, I must appreciate the Africa CDC. The Africa CDC reported to the country immediately after they heard of the outbreak. I was able to travel with them to the epicentre, and I tasked them with two items in the response plan. One was research on the source of the outbreak or the source of the virus, to date, they're carrying out the research in collaboration with other partners.
The second and most important was the community engagement, the training of village health teams and ensuring that we move door to door to empower the communities with information taking into consideration that outbreaks start in the communities and end in the communities. So, Africa CDC provided resources for training village health teams and supported village health teams to move, do to door both in Mubnde and in Kassanda. That was tremendous work done to the extent that every member of the community knew about Ebola Sudan, how to prevent it, and how to conduct safe burials using the safe burials teams. Africa CDC's efforts actually contributed a lot to controlling the pandemic within the 69 days. So I really must applaud the Africa CDC and their efforts and timely response to the situation.
- How do you describe the significance of effective leadership and coordination of the response during outbreaks and in gaining trust from the public?
A: First of all, I need to be very clear here that for any outbreak that occurs in any country, it is extremely important for partners to align themselves to the country's response plan and avoid parallel activities. Countries must take leadership and coordinate the partners, which is not easy. In that light, I want to appreciate the World Health Organization for recruiting expertise in that area to support in follow-up and notify us where every partner was.
I cannot overemphasise the issue of effective leadership. It is also important for the public trust their leadership especially as they explain about certain interventions and why they have to be implemented.
- Drawing experience from this last outbreak, what key issues must be addressed at the national and regional levels to support the early detection and control of disease outbreaks?
A: One of the most important lessons to learn is having readily available resources that you can quickly utilize to deploy your teams in real-time. So, I want to urge many African countries to set aside resources for outbreaks.
Number two is the importance of having laboratories, mobile laboratories that can be deployed at the national level, and at the regional level in the districts within the communities at any time.
Equally important, is to have well-trained human resources with the requisite skills and ready to be deployed anywhere at any time. I cannot overemphasise the need for well-trained laboratory personnel
- In your opinion, ever since the continent established its own public health agency the Africa CDC, what difference have you seen during this emergency response? How do you envision the Africa CDC in the next five years?
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A: Well, first of all, I must say I'm extremely proud of the Africa CDC I was one of the ministers that proposed the formation of the Africa CDC, and I have seen it grow. I have seen the efforts that have been put into it by the leadership who is handling it, and I have seen what the Africa CDC can do in response to an emergency. I can give an example at the height of the COVID-19 pandemic, the Africa CDC came in very handy to negotiate for vaccines for the African nations when we did not have vaccines at all.
Wherever we have had outbreaks the Africa CDC has responded with expertise and with financial resources. But in addition, the Agency has ensured that the African countries move in response harmony because an outbreak in Uganda could be an outbreak in any African country. So, bringing the African countries together and ensuring that they begin to develop capacity to respond in a manner that is required is extremely important.
So, I want to congratulate the Africa CDC, and I know it'll continue to grow and develop the capacity to reach out everywhere in real-time.
- As a public health leader, what advice would you give to rising African public health professionals?
A: First of all, we have to take note that epidemics will continue to occur in Africa. Right now, we have a Marburg outbreak in Tanzania, and many other nations will get outbreaks. So I want to underscore that Africa is able to handle epidemics and we saw this during the COVID pandemic. We are African countries that can marsh all the available resources and control the COVID-19 pandemic. Similarly, we have seen many countries working in collaboration with partners to control epidemics. We need to get our systems right and ensure that whatever public health emergency occurs does not interrupt or affect the essential services that we continue to offer because we have to move towards universal health coverage. Therefore, it is time to build resilient systems that can withstand any shock of any epidemic or any catastrophe that occurs.
