It seems that, as a country, we’re not focussing on what it’ll take to have our boarders and international airport open again; to have free movement within Uganda; and for business and public functions to resume.
If we’re thinking about this, then it’s likely that the challenges ahead are underestimated.
The crucial facts to contend with in addressing the strategic challenges are the following:
• Covid-19 is a highly contagious disease; with more than a million cases confirmed around the world in 3 months.
• A high percentage of those infected (est up to 50%) have no symptoms at all, while others have symptoms ranging from very mild (not needing hospitalisation) to very severe (requiring ICU hospital care). Since in many countries, those without symptoms are not tested, there is insufficient information on how many are infected.
• Those who don’t develop symptoms at all can still infect others; while, even those who develop symptoms become contagious early in their illness before symptoms exhibit.
• A small portion (1-10%) of those positively diagnosed with COVID-19 succumbs; others fully recover and develop immunity (whose duration is yet to be established).
• There are no vaccines and no certified medicines effective in prevention or cure of COVID-19.
The logical objectives of the measures we apply in responding to the pandemic ought to be the following:
1. Curtail the spread and effectively manage the infected.
2. Raise the general immunity of population and SARS CoV-2 (Virus) specific immunity.
3. Safely produce and exchange goods and services and have safe human interactions.
4. Deal with the socioeconomic, psychological and other consequences of the pandemic.
From the above facts about the pandemic and what the objectives of our responses ought to be, it’s evident that the responses in Uganda, and quite likely in other parts of Africa) are inadequate.
CURTAILING SPREAD AND EFFECTIVELY MANAGING THE INFECTED:
These measure are important for two main reasons:
• To buy time for vaccines and effective medicines to be developed. The reality being that sooner or later, everybody will get the infection, just like we get flu, its cousin.
• To avoid overwhelming the hospital (healthcare) capacity to manage patients and lead to high rate of deaths. In Uganda (and most of Africa), where the healthcare capacity is very low, this is even more critical.
WHAT NEEDS TO BE DONE?
The steps to take following the general behavioural changes to be adopted by the public (wash hands, stop physical closeness, safe coughing & sneezing etc) must be driven by scientific information and knowledge.
Scientific information and knowledge about the spread of this virus will be provided by investigation and research. The obvious starting point is to determine those infected with the virus and, hence, capable of passing it onto others. Secondly, determining those who have been infected, overcome the infection and developed immunity against the virus.
The second area of scientific investigation and research is one that creates capacity to immunise the population (vaccines) and to have effective drugs to cure the infection.
TESTING FOR COVID-19:
Presently, there is only one centre where testing is being (and can be) done: the Uganda Virus Research Institute (UVRI) in Entebbe.
The only test that is done in Entebbe (from swabs of the throat and nose), known simply as Polymerase Chain Reaction (PCR), can only determine who has the virus in their body (infected) but can’t determine whether one was infected, overcame the disease and developed immunity.
Even for the PCR test, it’s only those who were institutionally quarantined (detained) and those who have developed signs and symptoms of the disease that get tested. So far, less than 4,000 tests have been done in Uganda, from which 52 tested positive.
As earlier indicated, however, the majority of those who get infected, either, don’t get any symptoms at all or get mild symptoms that don’t alarm them to get tested. These infected, but untested, people will remain freely interacting with the public and (potentially) spreading the virus.
Those who’ve been infected, overcame the disease and have immunity are also unknown. Such people would no longer be under threat of getting infected, due to their immunity. It means that such people could go back to their businesses without fear of getting sick and/or infecting others. In order to know such people, a different type of test is needed; one that tests for ANTIBODIES (against the virus) in the BLOOD.
It’s important and urgent that we develop the capacity to test widely, both for the virus and for the antibodies (immunity). All our major health facilities should be checking for COVID-19- Sentinel Surveillance.
It’s also helpful to have capacity for understanding the changing nature of the virus itself. As the virus is confronted by people’s immune systems, it changes its nature (mutation), and with these changes, it’s aggressiveness can change also.
It’s knowledge from the above processes that would guide decision-making in how to safely get out of lockdown and to manage the pandemic in the long run.
IMMUNISATION AND TREATMENT FOR COVID-19:
The real end of COVID-19 threat will come from developing effective and safe vaccines and curative drugs.
Once the infective agent is clearly understood, as the COVID-19 now is, the processes for developing vaccines are well known. It takes competent human resource, funding (to develop the necessary facilities) and time.
This is an area in which our African or sub-regional countries would be pooling, both human and material resources, and working 24/7 to develop remedies. This goes to the heart of the existential challenge that Africans face.
UVRI was, until the 1977 breakdown of East African Community, part of EA regional body. Integrating and strengthening our regional research capacity is extremely urgent.
UVRI is now under the Uganda National Health Research Organisation (UNHRO), whose Board and Secretariat is supposed to set the “national health research agenda”; coordinate, facilitate and monitor the implementation of health research programs; establish and coordinate research collaborations; enforce ethical standards; provide clearance for publications; and to evaluate the research institutions under it. There are 5 other research bodies under UNHRO.
There are also other (Health) research regulatory authorities other than UNHRO, which include National Food and Drug Authority (NDA) and Uganda National Council for Science and Technology (UNCST). There are health research bodies in academic institutions and health facilities.
All this organisational maze of bodies has Boards of Directors, Secretariats and staff, whose work must be hard to coordinate, harmonise, synergise and, critically, to fund optimally. The little that’s done in these organisations is almost entirely dependent on donor money!
COVID-19 should jolt us up to the fact that it can’t be business as usual. Our health research effort must be urgently institutionally rationalised, prioritised and heavily funded.
Our institutions must be at the forefront of developing vaccines, rather than being used to test what others have developed. Covid-19 may quickly get vaccines because it’s a priority for those who have money and institutions to respond. Uganda and Africa can, and often has, different challenges from those who’re currently funding health research.
Similarly, relevant elements within the UVRI, the Natural Chemotherapeutic Research Institute (NCRI) and Uganda National Health Laboratories (UNHR), which are some of the UNHRO institutions, together with Uganda National Drug Authority (NDA), should be at the forefront of developing and/or testing medicines to combat COVID-19 and other diseases.
Uganda, East Africa and Africa at large, have very highly trained and competent scientists able to do amazing things in all these fields. What they need is organisational clarity and leadership on the one hand, and prioritisation in funding on the other.
Uganda’s budget framework for 2020/2021 provides 5.1% allocation to Health, down from 7.9% in 2019/2020!
The allocation has gone down 40% from Shs 2,589 billion to Shs 1,550 billion! The development share of the budget will be 17.2% next financial year, down from 43% this year (2019/2020)!
Compare the Health budget allocation with the following allocations for 2020/2021:
Interest Payments (debt servicing) 11.9%
Security 9.5%
Energy and Minerals 8.2%
Accountability 6.1%
Justice, Law and Order 5.9%
Public Administration & Public Sector Management 5.9%
Agriculture 3.2%
Parliament 2.2%
As COVID-19 has ably demonstrated, health has the capacity to stop the functioning of all other sectors! This shows how Uganda’s (and most of Africa’s) priorities are hopelessly warped.
CONCLUSIONS:
1. Urgently scale-up the capacity and scope of testing for COVID-19.
2. Urgently rationalise and streamline Uganda’s Health Research Organisations. In the interim, let’s have an independent COVID-19 professional body with an empowered leadership that guides the management of the pandemic.
3. Urgently scale-up Uganda’s research capacity in the areas of Antibody Testing, development of vaccines and medicines (especially anti-viral drugs). Effort should be made to link this capacity to that of our sub-regional and regional partners.
4. Urgently recast whatever remains of the 2019/2020 budget and grossly review the 2020/2021 budget to reflect the right priorities. The whole country must take very keen interest in this matter.
5. Lastly, Uganda’s governance system must be reviewed, equally urgently. The people of Uganda must be, earnestly, in charge of the affairs of their country and an accountable system of government must prevail. This is the system that would effectively prioritise people’s needs and efficiently deliver on them. This is the most difficult to achieve. The people of Uganda must first subordinate the guns, which have wielded power since independence. The struggle is on for people to regain their power. Be a part of it.
Kizza-Besigye.
8th April 2020.
