Uganda introduces its first Ebola lockdown while it waits for vaccines

Officials in Uganda have introduced a 21-day lockdown in the Mubende and Kassanda districts in a bid to tackle the ongoing outbreak

By Jason Arunn Murugesu

Red Cross workers place a coffin, containing someone who died of Ebola, into a grave on 11 October in Mubende, Uganda

Luke Dray/Getty Images

For the first time, officials in Uganda have introduced a 21-day lockdown in two of the country’s districts in a bid to stem rising Ebola cases.

Since 15 October, bars, entertainment venues, markets and places of worship in Mubende and Kassanda in central Uganda have been forced to shut. Only goods lorries will be allowed in and out of the districts over the three weeks. A curfew has also been put in place, forcing people to remain at home between 7pm and 6am.

According to Emmanuel Mutoo at the Foundation for International Medical Relief of Children, it is unclear why a lockdown has been introduced when previous Ebola outbreaks in Uganda had a higher number of cases.

As of 19 October, Uganda’s Ministry of Health had reported 60 confirmed cases and 24 confirmed deaths throughout the country.

Although the ministry doesn’t specify which districts these cases and deaths arose in, a World Health Organization (WHO) report details 58 confirmed cases throughout Uganda as of 14 October, of which 50 were in Mubende and three in Kassanda. Mubende has had 38 confirmed or probable deaths, compared with one fatality in Kassanda, according to the report.

Amid the ongoing outbreak, the first Ebola death was confirmed on 19 September – a 24-year-old man living in Mubende. The virus later killed six members of his family.

On 12 October, Uganda’s health minister, Jane Ruth Aceng, confirmed that a person had died from Ebola in the country’s capital, Kampala, more than 90 miles from the centre of Mubende.

The outbreak is being driven by the Sudan variant of the Ebola virus. Like all Ebola variants, this mainly spreads via contact with an infected person’s bodily fluids, such as blood or vomit. Symptoms can include fever, abdominal pain and unexplained bleeding.

In previous outbreaks, the estimated case-fatality rate of the Sudan variant has varied from 41 per cent to 100 per cent, according to the WHO.

No vaccine has been approved for this variant specifically. Two vaccines are available for the Zaire variant, manufactured by Merck and Johnson & Johnson. On 26 September, the WHO said it didn’t expect the Merck vaccine to be effective against the Sudan variant, based on available evidence. The two-dose Johnson & Johnson vaccine regimen hasn’t been tested against the Sudan variant in humans and the second dose must be administered at least 56 days after the first dose, making it unsuitable for an emergency response, according to the WHO.

Personal protective equipment for healthcare workers is in short supply, says Mutoo. Five healthcare workers have reportedly been killed by the virus so far.

Healthcare workers also fear cases may rise in more rural parts of Uganda where there is less advanced access to medical treatment and it may be difficult to trace contacts, says Mutoo.

Uganda’s government is attempting to stem the outbreak by tracing and isolating the contacts of people who test positive. “Some of the challenges with contact tracing is that some people don’t have phones and so you have to walk to find them, which takes time,” says Mutoo. “By the time you get there, they may have moved from this place or another.”

Among people who have phones, health officials may not have given them enough money or mobile data to call or message potential cases, while others haven’t been given enough money for fuel, according to Mutoo. “With the economy right now, everything is expensive,” he says.

Another challenge with contact tracing is that many Ugandans work in market stalls and therefore lose money if they stay at home for the 21-day isolation period. “Telling someone to keep home when they can’t have something to eat is difficult,” says Mutoo.

While there are no approved vaccines for the Sudan variant, at least six vaccine candidates are in development, according to the WHO. One, developed by the same team behind the University of Oxford/AstraZeneca covid-19 vaccine, is in production ahead of a clinical trial and will be deployed in Uganda in two weeks, says the WHO.

The US has also sent an experimental Ebola antibody drug, called MBP134, to help protect healthcare workers.

If there are no more deaths by the end of October, Mutoo will consider the outbreak under control. “I don’t want to lose faith,” he says.