Is Ebola an emerging pandemic?

Uganda has made leaps and bounds in terms of its emergency response to the deadly Ebola virus. Dr Issa Makumbi, the head of epidemiology and surveillance with the Ministry of Health, says the third time around health workers simply knew what to do. Their speedy response saved lives thanks to ongoing surveillance, vastly improved local knowledge from epidemic’s past, and the top of the line Uganda Virus Research Institute (UVRI) laboratory in Entebbe – one of only a handful on the continent able to perform rapid in-country testing.

“What is different from the outbreaks before is this time we were very prompt,” Dr Makumbi said. “Immediately we took action, we even supervised the burial – if we had not done that, it would have spread. Our immediate response has paid dividends.”

Hundreds to one
The Sudanese strain of the deadly Ebola virus first appeared in Gulu District in late 2000. It infected 425 people and killed 224, making it the largest-ever Ebola epidemic documented to date. In 2007, an entirely new strain emerged in the west. The Bundibugyo strain, named after the district where it was discovered, killed 37 people.

The current outbreak has already passed a crucial halfway point since the death of a 12-year-old girl in Luwero district on May 6. With no other confirmed cases by June 17, the Ministry of Health says the necessary 42 days will have passed after which they can declare the epidemic over.
Uganda’s unique position of having had three outbreaks within 11 years has also made it a valuable candidate for research. But while local knowledge has drastically improved on how to control the outbreak spreading, Ebola remains a mystery in more ways than one.

The Makerere University Walter Reed Project (MUWRP) is currently in the first phase of developing an Ebola vaccine. Dr Salim Wakabi, the Ebola researcher heading the vaccine’s development, said it will be at least five years before all necessary testing is through. “If it is successful, if it goes through the three phases and we’ve seen that the vaccine works, then if there is an outbreak like now we can go ahead and administer the vaccine to the people that are prone,” Dr Wakabi said.

The project is looking into two anomalies of the virus that as of yet have not been able to be explained – namely, why despite having such a high mortality rate, some still survive. Those survivors are the key to discovering how a vaccine can be developed. “The turn up was overwhelming when we started the vaccine trial – because people appreciate and know the problem is with us,” he said.

Though research is still ongoing, initial results in Bundibugyo have shown a number of survivors primarily complain of weakened hearing and vision. It demands a deeper look into the long-term implications of those infected by the virus, Dr Wakabi said.

The United States is the only other country trying to develop a vaccine. Last year, it successfully developed an experimental version was which was found to cure the virus – but only if the shot was able to be administered within 30 minutes of someone being infected.

While this is an unlikely solution to epidemics, it could potentially save the lives of health workers too often infected on the job. Uganda has lost a number of health professionals to the Ebola – including the renowned Dr Matthew Lukwiya. His quick response to Uganda’s first epidemic in 2000 was said to have saved hundreds of lives. About 1,850 cases with over 1,200 deaths have been documented since the Ebola virus was discovered in 1976.

Making way
It took more than two decades to make its way to Uganda from its roots in neighboring Congo – and no one has yet been able to explain why. “It’s becoming like cholera, every time now and then we get it,” said Dr Makumbi. “You can see the frequency, you don’t know maybe in three years we could see it pop up again.”

Dr Makumbi suspects the virus has a lot to do with Uganda’s population pressures. “We used to be further away from monkeys and wild animals, now we are a bit closer, sometimes we fight for the food, we fight for land – all these come in,” he said. “We are invading the ecosystem of the species.” He says the virus is in wild animals, but that non-human primates – monkeys and gorillas – are not likely host candidates, because of their high mortality rates as well. “That’s actually the other thing we want the public to report – if you see wild animals dying in masses, that is very suspicious,” he said.

According to the World Health Organisation, who provide much of the technical support in fighting Ebola epidemics, bats infected with the virus have not died, and may be a part of maintaining the virus’ natural reservoir, which “seems to reside in the rainforests on the African continent and in the Western Pacific”. Despite years of study, its roots of are still unknown.

Not yet there
Dr Makumbi says Uganda’s health system is not nearly as efficient well-equipped between emergencies as it is during...... “If it is something that is a global, public good – then everybody will come here, we can be overwhelmed by partners, everybody wants to lend a hand, everybody,” he says. “But this general, routine, capacity-building strengthening – they come, but not at full speed like the way they come for AIDS, Ebola, Yellow fever.”

Without emergency-sized budgets and personnel to help out, Uganda’s consistent shortages in health service delivery – staff and drug shortages, equipment, wages and accessibility – will likely prevent a more forward-looking approach to disease preparedness.

On top of that, despite the constant addition of districts has stretched the health budget thin, which has already remained at the same level for years. “The population is increasing, the districts are increasing, so we need more people – but wage bill is not enough,” Dr Makumbi said.