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Guest Essay
Dr. Lamorde is an expert on the management of infectious diseases in developing countries. He is the head of the global health security program at the Infectious Diseases Institute at Makerere University in Kampala, Uganda.
Early in the pandemic, Uganda bought itself precious time at great economic cost to protect its people from Covid-19.
There were lockdowns, international travel was restricted, and border screenings were introduced to prevent entry of the coronavirus. Cases of Covid-19 identified at borders or in communities were isolated, and people who had been in contact with those infected were quarantined and checked on by public health authorities.
These measures were meant to minimize the impact of the pandemic until drugs and vaccines could be found and distributed. However, as of July 6, only about 2 percent of Ugandans are vaccinated. There were more deaths reported in the month of June than total deaths reported since the start of the pandemic. This was not the outcome that we had hoped for.
People are understandably frustrated and afraid. Since the beginning of the pandemic, there has been a bargain on the table: Lockdowns and other health measures can cripple society in painful ways, but that pain is temporary and in service of the larger goal of defeating Covid-19. People endure the lockdowns because help is on the way. But what happens when a society does everything right, buys time and flattens the curve, and then help doesn’t arrive, or it’s insufficient? That’s what’s happening in Uganda.
As some countries reopen, Uganda is under lockdown until the end of July. Schools are closed, public gatherings at churches and mosques are on pause, and public transportation is mostly shut down. Nonessential stores and businesses, offices and movie theaters are also closed.
Uganda is in a precarious situation, but it’s not because the country hasn’t acted aggressively. Four years ago, the global health security program at the Infectious Diseases Institute at Makerere University in Kampala was created. We’ve worked closely with the government and partners such as the United States’ Centers for Disease Control and Prevention to prevent, detect and respond to diseases that cause outbreaks like Ebola, Marburg and pandemic influenza.
When the new coronavirus emerged, our teams immediately embedded within the Ministry of Health and helped develop border screenings, laboratory testing capacity, community surveillance and infection control in health clinics and hospitals. Despite limited resources, Uganda was running a highly successful Covid-19 response, reporting fewer cases and deaths than other countries of similar population size.
But once variants of the coronavirus were detected in Uganda, it was clear that the country needed to prepare for the worst. The Delta variant, which is more transmissible, is now circulating here. There is a huge surge in Covid-19 cases, with hospital treatment units going from nearly empty to full within days. Alarmingly, there are now more patients with severe illness in this wave, including patients requiring oxygen support. The national stadium that was originally repurposed as an isolation unit for patients with mild or no symptoms is now admitting people needing oxygen when no beds were available at the hospitals around Kampala.
Thankfully, all vaccines for Covid-19 approved by the World Health Organization are safe and effective for preventing death and serious illness. We can now confidently say that Covid-19 is a preventable disease. Sadly, unless immediate action is taken by wealthier countries with vaccine stockpiles, vaccine shortages in the face of surging cases and deaths will be an enduring legacy of the Covid-19 outbreak in Uganda and the rest of Africa.
In March 2021, Uganda began a vaccination program that aimed to eventually reach 50 percent of the population despite limited vaccines. The country, which has a population of around 44 million, received just 864,000 doses of the AstraZeneca vaccine through Covax, the World Health Organization’s initiative to pool vaccine resources, and 100,000 from India. To ensure the vaccines would reach those at highest risk for death, health workers, people age 50 and older, patients with underlying conditions, teachers and security personnel like the police and military were prioritized. While the first batch of vaccines was being administered, Covid-19 cases started to rise. Doses from the first batch were quickly exhausted because of increasing demand, and the vaccination plan was interrupted. Vaccination restarted in late June with only 175,200 doses available from Covax via France, primarily reserved for people due for their second dose.
Despite the effort to get high-risk people vaccinated, Uganda lost many doctors and other health workers, school staff members and security personnel within days in June. Stories of fear and loss are widespread across the country, and people are sharing on social media pictures of family, friends and loved ones who have passed away.
Other countries in Africa, including Zambia, Namibia and South Africa, are facing a similar crisis. What is most alarming to me is that even countries such as Nigeria, which had reported a decline in cases in the past few months, could transition to a crisis within a matter of weeks if more transmissible variants spread. Ideally, all African countries could perform genomic sequencing to identify and track more transmissible variants that may signal a worsening trajectory of the outbreak across the continent. But that’s not possible yet.
Vaccination remains the key measure to end this pandemic. But to rapidly scale up vaccination in African countries, we will need access to low-cost vaccines. Supply chains for vaccine production must be secured for manufacturers worldwide. Developing countries that have capacity to produce vaccines need licenses or waivers to use the intellectual property of drug companies to produce more vaccines at lower cost. Negotiations for waivers are progressing slowly at the World Trade Organization.
The most valuable resource we have right now is not money, but time. And we are losing it.
Covax brought initial doses of vaccines to Uganda and many other countries. But this initiative has been weakened by insufficient investment from other countries and the fact that India is no longer exporting its vaccines in order to meet the country’s own needs.
Countries with an abundant stock of vaccines have begun to donate some of their stock, and this is welcome. But the emergence of the term “vaccine diplomacy” is concerning. While humanitarian on its surface, it represents a political rather than science-based effort. Countries with weak bilateral relationships to negotiate for vaccines may be left behind, creating geographic zones of unfettered viral spread and allowing even more dangerous variants to emerge. Individual developing countries facing a crisis may be unable to resist the allure of bilateral vaccine deals, but what is needed right now is a global resolve to end this pandemic equitably.
We have the tools and resources to change the natural course of this outbreak. The world must continue to build global vaccine stockpiles that can be deployed fairly so that priority groups like health workers in every country get them first. Whenever variants emerge, vaccination must be scaled up in affected countries along with other public health measures. Vaccination hesitancy should also be addressed worldwide to combat myths. However, addressing hesitancy can feel pointless if there are no vaccines.
Uganda has fought and overcome numerous infectious disease outbreaks in the past. This challenge is daunting, but I am optimistic that with support, Covid-19 will not be an exception.
Mohammed Lamorde is an expert on the management of infectious diseases in developing countries. He is the head of the global health security program at the Infectious Diseases Institute at Makerere University in Kampala, Uganda.
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