The Frontline COVID-19 Response in Uganda
Rachel Kulchar, Princeton University
Covid-19 Comparative Analysis
COVID-19 has become a household term as it has reached over 200 countries, giving a total infected count of over 100 million individuals, and leaving over 2 million dead.[1] Despite this radical ubiquity, COVID-19 has not had the same effect in all of these countries. When examining the total cases per 1 million people for each country, it may be surprising to find that the top 20 countries for the worst ratio[2] include developed nations, such as the United States, Spain, and Switzerland. Meanwhile, countries that are considered to be much less developed have had markedly better outcomes. A pandemic of this scale will stress test all countries’ pandemic responses and allow for much better insight into what makes for successful and unsuccessful plans. That being said, the trend of some developed countries having worse outcomes than developing countries requires further investigation. One developing nation in particular, Uganda, has performed especially well during the COVID-19 pandemic despite having fewer resources, worse infrastructure, and less education than the United States.[3] The countries’ respective literacy rates are telling figures exemplifying the disparities in education with Uganda at 76.5% and the United States at ~99%.[4]
Preemptive Measures Taken
Uganda, an East African country with a population of about 47 million, has approximately 850 cases of COVID-19 per million people in the country (0.85%), compared to 80,498 in the United States (~8.05%) and 60,525 in Spain (~6.05%).[5] The first case of COVID-19 was confirmed in Uganda on March 21, 2020; however, the government’s response began before then and the preemptive work helped to curb the initial spread.[6] In fact, Uganda didn’t break the 1,000 cases threshold until July 2020.[7] Some of these preemptive measures included restricting travel that engaged high-risk countries and dispersing groups or situations that drew out large gatherings, some of which included schools, colleges, and other religious and social assemblies. Additionally, there were enforced mandatory quarantines for all travelers.[8]
Another important preemptive measure, that has been in place throughout the pandemic, was transparent and effective communication. In Uganda, the Ministry of Health continuously emphasized the importance of COVID-19 related communication via presidential speeches, television and radio broadcasts, posters, and social media. These measures, in addition to a COVID-19 communication webpage, have ensured all information to be publicized and accessible.[9]Through these campaigns, the Ministry of Health was able to convey disease risks and other disease preventative measures, such as handwashing, social distancing, and mask-wearing. Furthermore, they implemented specific guidelines regarding masks and social distancing rather than just general encouragement.[10] They focused on educating the public on the difference between medical and non-medical masks, how face masks work, what type of masks the community should use, the effectiveness of cloths in lieu of a face mask, how to dispose of masks, the specifications for homemade masks, if air conditioning should be used during Covid-19, etc. Instead of merely telling people what they should do, Uganda aimed to tell people why they should do those things.[11]
Despite the relatively few cases the country has been faced with, the Ugandan government has taken many precautionary measures, leaving Uganda more prepared than most other countries. These precautionary measures came from a sense of urgency that was also in many other smaller GDP nations. Governments in many of these lower-income countries enacted lockdowns quickly to initial exposure of Covid-19 while countries in the global north responded much more slowly. This only provides additional evidence and underscores the importance of strategic action at the start of an outbreak.
Tradeoffs
Although Uganda’s swift response to the initial outbreak had many positive benefits, the tradeoff between enacting restrictive policies and allowing the situation time to unfold is one of real economic importance. In particular, restrictive policy hurts the economy in at least one of the following categories: a) increased unemployment due to inability to work or severe reduction in customers b) losses in tourism income c) international trade revenue declines d) foreign exchange deterioration. Various simulations of lockdown durations have shown direct correlations between the duration of lockdown and increasing poverty rates showing that the difference between a four and eight week lockdown can increase poverty rates by 5% if there is no additional government intervention, which again is an economic burden.[12] These studies show that when deciding policy in the wake of an outbreak, the importance is not necessarily in the binary dichotomy of having restrictive policy or not, but rather the nuance of speed and efficacy of the restrictive policy. In the case of Uganda, an additional month of lockdown could result in millions of citizens falling into poverty.[13] The study also found that the key was effective and swift action to have the shortest window of the country’s pandemic exposure, which is exactly what Uganda did rather effectively.[14]
Testing Policy
In another vein, one of the primary determinants for a country’s pandemic response success is their testing policy. For African nations in general, this is also the primary struggle, given their lack of resources and infrastructure to facilitate the creation and distribution of test kits. Early on when there were fewer than 60 confirmed positive cases, bioinformatics and genomics researcher at Uganda's Makerere University, Gerald Mboowa, told The Lancet Microbe, “There may be 100 suspected cases, but they will not test everyone…because there are very few test kits”.[15] That being said, within the context of African testing, Uganda had some reasonable success. They had slightly better testing numbers than the rest of Africa, surpassing the number of tests per million people in Africa of 8932 with 9084.[16] Moreover, that average for all of Africa is skewed by very high per million numbers in countries with smaller populations, such as Mayotte, Capo Verde, and Djibouti.[17] Uganda overcame this hurdle of a shortage of tests because of their distinguished facilities which prepared them to thrive under a pandemic.
After dealing extensively with Ebola, yellow fever, Marburg Viruses, measles, and the Crimean-Congo hemorrhagic fever, many African countries—including Uganda—acted with haste. The experience with viral disease Uganda has acquired throughout the years has given them advantage over other countries in dealing with Covid-19, health experts claim.[18] For example, since the year 2019, body temperature scanners became integrated at the Entebbe International Airport; this has made detection of illness much easier.[19] Also, because of Uganda’s prior encounters with viral disease, they have the capacity to quickly prepare and test samples of various viral diseases at the Uganda Virus Research Institute Laboratory.[20]
Community Based Disease Surveillance
In addition to testing, there are other important means for understanding the spread of COVID-19 in various communities. In particular, Uganda excelled in implementing their Community-Based Disease Surveillance (CBDS) and contact tracing model.[21] The CBDS has been hailed as a “game changer” in COVID-19 response.[22] In the Rakai District, early detection of the first four community cases were made possible through the vigilance of local health professionals under CBDS guidance. Evidence shows that positive cases and contacts have been detected through CBDS in several districts including border communities. The CBDS was largely successful because of the strong administrative structures in Uganda at the village and grassroots levels.
Conclusion
The success of the Ugandan pandemic response both within an African and global context is an important takeaway, and the precedent that Uganda set by being a developing nation that outperformed developed ones should not be overlooked. Within the African context, Uganda has outperformed the top three largest African economies of Nigeria, South Africa, and Egypt, as these three countries had the highest level of outbreaks in terms of COVID-19 cases.[23] Additionally, within the global context they have outperformed even the most developed nations, such as the United States and the United Kingdom.[24] In doing so, it illustrates that successful responses can emerge despite barriers posed by GDP, infrastructure, average income, or even standard of living.
In modern times, a pandemic response requires a concerted and coordinated national effort. It requires multifaceted approaches revolving around effective leadership, evidence-based risk communication, and strategic public health interventions such as mass testing, contact tracing, isolation and quarantining of affected individuals, hand hygiene, and social distancing measures. Additionally, the emphasis on the critical role of building local capacity is imperative.[25]The Ugandan response serves as a great teaching moment for many other nations that struggled or had poor efforts for the first wave of COVID-19. With the possibility of further surges of COVID-19 and the inevitability of another disease on some scale, it is never too late to implement systems that will keep people safe, healthy, and alive.
Works Cited
[1] “Countries Where Coronavirus Has Spread - Worldometer,” accessed February 15, 2021, https://www.worldometers.info/coronavirus/countries-where-coronavirus-has-spread/.
[2] “Coronavirus Update (Live): 109,640,884 Cases and 2,417,604 Deaths from COVID-19 Virus Pandemic - Worldometer,” accessed February 15, 2021, https://www.worldometers.info/coronavirus/?utm_campaign=homeAdvegas1?
[3] Ahmed M. Sarki, Alex Ezeh, and Saverio Stranges, “Uganda as a Role Model for Pandemic Containment in Africa,” American Journal of Public Health 110, no. 12 (November 12, 2020): 1800–1802, https://doi.org/10.2105/AJPH.2020.305948.
[4] “Literacy Rate by Country 2021,” accessed April 20, 2021, https://worldpopulationreview.com/country-rankings/literacy-rate-by-country.
[5] “Coronavirus Update (Live).”
[6] Ronald Olum and Felix Bongomin, “Uganda’s First 100 COVID-19 Cases: Trends and Lessons,” International Journal of Infectious Diseases 96 (July 2020): 517–18, https://doi.org/10.1016/j.ijid.2020.05.073.
[7] “COVID-19 Map,” Johns Hopkins Coronavirus Resource Center, accessed February 15, 2021, https://coronavirus.jhu.edu/map.html.
[8] Sarki, Ezeh, and Stranges, “Uganda as a Role Model for Pandemic Containment in Africa.”
[9] “Uganda’s Emergency Response to the COVID-19 Pandemic: A Case Study,” n.d., https://thinkwell.global/wp-content/uploads/2020/09/Uganda-COVID-19-Case-Study-_18-Sept-20201.pdf.
[10] “Uganda’s Emergency Response to the COVID-19 Pandemic: A Case Study.”
[11] Home - COVID-19: Ministry of health. (2020, March 22). Retrieved March 17, 2021, from https://www.health.go.ug/covid/
[12] UNDP-Uganda, “Socio-Economic Impact of COVID-19 in Uganda,” Policy Brief (Uganda, April 2020).
[13] UNDP-Uganda.
[14] UNDP-Uganda.
[15] Paul Adepoju, “Africa’s Struggle with Inadequate COVID-19 Testing,” The Lancet. Microbe 1, no. 1 (May 2020): e12, https://doi.org/10.1016/S2666-5247(20)30014-8.
[16] Sarki, Ezeh, and Stranges, “Uganda as a Role Model for Pandemic Containment in Africa.”
[17] “Coronavirus Update (Live).”
[18] Baleke, M. (2020, April 21). How Uganda's history of epidemics has prepared it for COVID-19. Retrieved June 27, 2020, from https://www.pbs.org/newshour/show/how-ugandas-history-of-epidemics-has-prepared-it-for-covid-19
[19] Baleke, M.
[20] Baleke, M.
[21] Sarki, Ezeh, and Stranges, “Uganda as a Role Model for Pandemic Containment in Africa.”
[22] Sarki, Ezeh, and Stranges.
[23] Sarki, Ezeh, and Stranges.
[24] Sarki, Ezeh, and Stranges.
[25] Sarki, Ezeh, and Stranges.