In the early morning of August 26, 1976 a school teacher visited his community in cotton growing areas of Zana in Sudan (the current South Sudan) and on his way back home, he bought game meat to be consumed at home in Yambuku. Literature shows there was a simultaneous outbreaks in the Sudan (current South Sudan) in 1976. He was a teacher at Yambuku Catholic Mission School and when he fell sick was admitted in Yambuku Missionary Hospital and he was identified as Mr Lokela Malabo, 44.
Initially, he was treated for malaria and a week later, he had uncontrolled vomiting, bloody diarrhoea, bleeding from the nostrils, mouth and rectum and sadly he died on the September 8, 1976 after the onset of his symptoms. This was in Kikwit and an outbreak thereafter ensued with 318 cases and 280 deaths giving a mortality of 88 per cent with 38 serologically confirmed survivors.
The Ebola virus was later renamed strain Mayinga (WHO, 1978) the prototype virus after the first nurse victim, Mayinga N’Seka, who died in the early days of the outbreak after attending to Malabo Lokela. Little was known about the mysterious disease and little would we think decades later that his demise would destabilise nations and cause WHO to announce global emergency during the devastating outbreak of Ebola in West Africa.
In the changing second and third decades after its initial outbreak, Uganda experienced its recorded Ebola outbreak in 2000 with its toll. However, the dynamic changes in world security landscapes, the terror attacks, anthrax scares has amalgamated the landscape of global health security. Let’s consider the various aspects of these landscapes which have changed in the past four decades since the first outbreak and contrast it with the regional preparedness. It is true that Uganda has had its share of outbreaks and contained it successfully thanks to the political leadership, partner support and the commitment of dedicated health workforce through the years. Globally, close to 15,000 people have been killed with a proportionate number of healthcare givers since the initial outbreak in Zaire (now DRC) in 1976.
The outbreak now has a direct effect on the healthcare of nations and the region. Disrupting standard medical care for both common and deadly conditions, socio-economic activities both at micro- and macroeconomic levels. Culminating into the biggest social disruption, insecurity of countries that are struggling either to put out insurgency or struggling to recover from decades of war.
The launch of Global Health Security Agenda (GHSA) in February, 2014 capped over a decade of global efforts to develop new approaches to emerging and re-emerging infectious diseases. Part of the growing recognition that disease events, whether natural, accidental or intentional threaten not just the public but national, regional and global security interests.
Regional states/global health community’ should coordinate resources for capacity building and emergency responses and develop core capacities required to predict, detect, assess, report and respond to potential public health emergencies of international concern. Let the regional global health community elevate political attention and encourage participation, coordination and collaboration by multiple stakeholders while leveraging previous existing communities and multilateral efforts.
Remember the GHSA and the IHR (2005) are platforms for action and we hope efforts under each can complement global/regional health security. Regional health communities should increase progress under the two overlapping frameworks focusing on resources and effort to sustain political momentum. Uganda has direct interest in safeguarding the health of its citizens and in preventing the threats posed by disease in the region, and the wider world.
Epidemic and endemic diseases can undermine economic growth and fiscal stability and hence threaten political security of the countries in the region. Emerging infectious diseases of epidemic and pandemic proportions pose serious threat to Uganda and East Africans. Health concerns should, therefore, begin to emerge on foreign and security policy agenda of east and central African countries incorporate into the trading or political policy agenda. There should be a deliberate policy shift clearly observing the relationship to biological weapons, especially items of biosecurity agents that can easily be weaponised into crude simple but deadly aerosol weapons delivery systems.
In the conflict prone region, Ebola can still be used as a weapon of war as has been the cases of rape and withholding vaccination campaigns in the region. Principally through deliberate contamination of surfaces as was the cases of vandalising the Ebola Treatment Centre (ETC) in DRC which should constitute war crimes and crimes against humanity.
However, while we can inappropriately construct a link of Ebola to east and central Africa, the global ease of movements of global health communities risk skewing and paying a blind eye to dangers of globalization and global health agenda.
Considerable attention has, therefore, to be focused on links between health, foreign and security policies in areas of infectious diseases and bio-terror. However, what is unclear is the extent to which poor health can contribute to internal instability and whether improved health care can stabilise states. The argument is still poor health can destabilise in two ways. One it undermines the economic and social structures of the state and secondly, it causes social disorder, by highlighting inequalities.
In conclusion, the East African member states must not allow Ebola and other outbreaks to change the game or shift the goal posts of global health security agenda.
Dr Elima is the director, Gulu Regional Referral Hospital.