In an interview between Africa CDC and the Minister for Health in the Republic of Uganda, Dr Jane Ruth Aceng, the Minister described the country’s approach to the recent outbreak of Sudan ebolavirus. Emphasising that “time matters”, she explored the lessons that Uganda and neighbouring countries could learn from this most recent outbreak in time for inevitable future outbreaks. Here we explore how her answers can inform future practices and what areas for improvement or support can be identified for partners.
The outbreak emerges and a response is formed
The outbreak of Ebola Sudan was detected in Mubende District in September 2022. Dr Aceng suggests that this “came as a shock” but also found the country “relatively prepared”. Thanks to previous investigations “regarding Marburg virus” in the region, and an earlier outbreak in Chebale, the location “wasn’t a fresh area”. However, health officials are “still interested” to better understand the origin of this outbreak.
The immediate response was informed by previous EVD outbreaks in the past, with seven occurring since 2000. Dr Aceng indicates that from that experience, Uganda “started putting systems in place for early detection and response”.
“We expanded laboratory capacity to the extent that we have several mobile laboratories that we can deploy anywhere at any time.”
Furthermore, the country implemented a Field Epidemiology Training Programme (FETP), to increase the armoury of epidemiologists who could respond to outbreaks. The sample transport network was addressed, and village health teams were trained. Finally, the commission of emergency operation centres meant that activities and alerts could be viewed in “real-time”.
Learning from success
Africa CDC also asked Dr Aceng about Uganda’s effective approach in the outbreak. She suggests that the first is “community ownership, community engagement, and community surveillance”.
“When communities are empowered, they do miracles!”
The role of internal communication and education is emphasised, with Dr Aceng suggesting that when a community understands the problem, they are well-placed to work with responders. Another key lesson from the outbreak is having laboratories at the epicentre, which enables efficient and effective diagnostics. Additionally, response teams should be “highly trained” and “ready to respond in real-time”. The fourth factor, Dr Aceng suggests, is “partnerships and collaborations”.
“Partners come in with resources, not only financial resources but also technical resources and knowledge that can contribute to controlling epidemics in real-time.”
When asked about what other African states could learn, Dr Aceng highlighted that “time is of essence”.
“Time matters! Time of reporting, the time of detection, and the time of declaration.”
This is specific to each 24 hours, Dr Aceng suggests, which allows the country to identify contacts and respond easily. Related to time, the declaration of an outbreak must be ensured to promote international and internal awareness. Another lesson is that of containment.
“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.”
Dr Aceng concluded her answer to the question on lessons for other states with an emphasis on the importance of the Accountability Forum.
“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.”
WHO outlined the goals of the outbreak-specific Accountability Forum in January 2023:
- To track the resources so far mobilised by each Development/Implementing Partner and from WHO
- To elaborate in detail the expenditure on resources mobilised by item by each Partner. Partners to indicate the administrative costs they are charging on the funds received
- To explain the rationale for expenditure on the items mentioned above in relation to the EVD National Response Plan
- To highlight the achievements so far as a result of the above expenditures.
Advice to public health professionals
During the interview, Africa CDC asked Dr Aceng what advice she might give to “rising African public health professionals”. Her first response recalls the importance of a realistic optimism.
“We have to take not that epidemics will continue to occur in Africa.”
Referring to the Marburg outbreak in Tanzania and other possible future outbreaks, she identifies in previous situations, such as the pandemic, an ability to “marshall all the available resources”.
“I want to underscore that Africa is able to handle epidemics.”
However, she also offered more practical advice. She highlighted the need to “get our systems right” and prevent emergency situations from disruptions to essential health services: “we have to move towards universal health coverage”.
What advice would you offer to African public health professionals? How do you think the global and African communities can learn from past and present outbreaks to develop a resilient response model for the future?