Members of the Ugandan Medical staff at the Ebola Treatment Unit stand inside the ward at Mubende Regional Referral Hospital in Uganda last month. On September 20, the health authorities in Uganda declared an outbreak of Ebola after a case of the Sudan ebola virus was confirmed in the Mubende district and registering three deaths including a 12-year-old girl. Picture: Badru Katumba/AFP
By Adam Taylor
A new outbreak of Ebola has sent shockwaves through the global health community. Uganda announced this week that 19 people had so far been confirmed to have died of the virus since last month, with the latest case found in the capital of Kampala – a city of more than 1.5 million people.
Though there is a vaccine for Ebola, it does not work on the strain spreading in Uganda. Ebola is a fundamentally devastating virus. If a person gets infected, their immune system and blood vessels effectively melt down as the virus takes over and causes a viral haemorrhagic fever.
The symptoms can include vomiting, diarrhoea, and internal and external bleeding. Death is usually swift, brought on by multiple organ failure. Although the fatality rate can vary drastically depending on circumstances, the World Health Organization says roughly one in two people who are infected with the virus die. Its visceral impact also sparks fear.
Eight years ago, Ebola caused an international panic when it spread widely in West Africa. Donald Trump, then best known as a roguish businessman turned reality television star, tweeted that American aid workers who contracted the virus abroad should not be allowed home and instead be made to “suffer the consequences!”
The outbreak ultimately led to more than 11000 deaths, almost all of them Africans. But the world has changed a lot since then. Perhaps the most crucial change since the 2014 Ebola outbreak is obvious: The world suffered through a global pandemic with coronavirus.
On paper, Ebola may look like a far scarier prospect than the coronavirus that began spreading from Wuhan, China, in late 2019. Even during the first wave of the pandemic, its fatality rate peaked at less than 15% in the worst-hit countries and it is now below 1% in much of the world.
But the coronavirus travelled far more easily than Ebola. It could spread through droplets in the air, whereas Ebola required spreads through physical contact with bodily fluids from someone who is sick or has died from the virus. People who have become recently infected with Ebola and who do not yet have symptoms cannot spread it; in 2014, many early cases of Ebola were spread through funeral traditions that involved washing the body.
The coronavirus spreads far more quickly, which made it so much harder to handle. At least 6.5 million people have died from Covid-19, though estimates of the real toll are far higher. Even the direst predictions for Ebola are not anywhere near that figure.
In theory, there should be positive lessons to learn from the coronavirus pandemic. For rich countries, this wasn’t just a distant outbreak in a faraway place, but the reality of global health on their doorsteps.
Vaccines were developed at breakneck speed and sent all around the world, the key reason that coronavirus fatality rates are now so low.
Health workers, the most at risk from both viruses, were praised as heroes. But for a country like Uganda, the lessons learned from coronavirus look more like cautionary tales. Even amid the global threat of the coronavirus, major countries like the US and China refused to co-operate.
At the peak of the pandemic, South Africa was ostracised for its early reporting on a new variant. Rich countries hoarded vaccine doses while poor nations went without – even now, less than a third of people in Africa are fully vaccinated against Covid-19.
Anti-vaccination sentiment spread worldwide, often spread by powerful voices in wealthy nations. And now, as the interest in the pandemic declines in much of the wealthy world, interest in other global health problems is dwindling, too.
Speaking this week in Kampala, Ahmed Ogwell, the acting head of the Africa Centers for Disease Control and Prevention, pointed to Africa’s recent experiences with monkeypox, another potentially deadly virus that has spread widely this year.
“Recently, during the pandemic, when we saw the number of monkeypox cases growing here in Africa, we issued a global alert but no help came to Africa,” he said, according to the Associated Press.
“In fact, today, as we see the tail end of the pandemic, there’s still no help coming to Africa for monkeypox,” Ogwell added. “This means that we need to check the reality that is with us, and the reality for us is that when a public health crisis is big, like the pandemic, Africa is on its own,” he said. Health workers in Uganda are hampered by a lack of tools.
The symptoms of the Sudan strain of Ebola can be similar to malaria, even though the requirements for treatment and measures to prevent the spread are starkly different.
There is only one government-run facility capable of identifying Ebola in the country – the number of suspected deaths in Uganda is double the 19 confirmed with laboratory tests. And while there is a vaccine for Ebola, it was designed to work on the Zaire strain of the virus which caused so much devastation during the West Africa outbreak and later in the Democratic Republic of Congo.
There is not yet a proven vaccine for the Sudan strain, though WHO director-general Tedros Adhanom Ghebreyesus said on Wednesday that a clinical trial would begin on one candidate within weeks.
Anyone holding their breath for an Operation Warp Speed-style rapid development and deployment of vaccines, as seen during Covid-19, is likely to be disappointed.
That $18-billion sprint for a vaccine – spearheaded by Trump who once spread fear about aid workers with Ebola – only began in mid-May 2020, by which point almost 90000 Covid deaths had been recorded in the US alone.
The Ebola outbreak in Uganda is unlikely to ever threaten the US on the same scale, especially with authorities screening for the virus at airports. But as Devi Sridhar, chair of global public health at the University of Edinburgh, wrote for the Guardian this week, survival bias from those who made it through Covid is impacting the way we think about global health risks now in a post-vaccine era.
“Infectious diseases far afield are always only just a plane ride away,” Sridhar wrote. “For both humanitarian and for self-interested reasons, there’s a clear imperative to stop outbreaks wherever they happen.”
* The article was first published in The Washington Post.