Uganda battles new Ebola outbreak — and a vaccine hesitancy crisis
Amid sixth outbreak of Sudan Ebola virus, Ugandans bemoan lack of official communication and fears for the economy.
Kampala, Uganda – A month after an Ebola outbreak struck Uganda in September 2022, Edward Kayiwa began feeling unwell: headaches, fever and muscle pain. He knew something was wrong, and that he had two options – go to a hospital or believe the rumours that were circulating in his community and stay home.
“I knew I was infected, but the fear was overwhelming,” the 32-year-old truck driver told Al Jazeera about the epidemic that lasted four months and killed 55 people.
list of 3 itemslist 1 of 3 Virus hunters: The scientists tracking deadly diseases in tough conditions
list 2 of 3 Uganda confirms one person dead in Ebola outbreak
list 3 of 3 Uganda starts clinical trial for Ebola vaccine after latest outbreak
end of listHis fear stemmed from conspiracy theories that patients treated in the community were being injected with substances that killed them instantly. It took him two days to realise no one was being killed and some were even recovering. After that, “I personally called an ambulance to pick me up,” he says.
The 2022 health crisis was Uganda’s seventh outbreak of Ebola – a highly infectious hemorrhagic disease – and its fifth of the Sudan virus (SVD) strain, which has a more than 40 percent fatality rate.
Kayiwa – one of 142 confirmed cases that time – was lucky to survive, though many others were not.
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Now, just two years later, on January 30, 2025, Uganda announced its latest Sudan Ebola outbreak. The Ministry of Health identified a 32-year-old male nurse who had died as the first documented case. He was an employee at Mulago National Referral Hospital, the country’s top medical facility.
The nurse initially developed fever-like symptoms and sought treatment at two health facilities in the greater Kampala area and another in eastern Uganda, near the Kenyan border.
While there is no approved vaccine for the Sudan Ebola strain, a vaccine for the Zaire Ebola strain – which caused the 2013-2016 West Africa epidemic that killed more than 11,000 people – was developed and approved in 2022. The Zaire strain, which was first discovered in 1976 in the Democratic Republic of the Congo (then known as Zaire), is the most lethal of the four ebolaviruses in existence.
“In the absence of licensed vaccines and therapeutics for the prevention and treatment of SVD, the risk of potential serious public health impact is high,” the World Health Organization (WHO) said about the current outbreak in Uganda.
According to the WHO, Ebola symptoms appear between two and 21 days after infection, and can include fever, severe headache, muscle pain, fatigue, abdominal pain, diarrhoea, vomiting, and bleeding from the nose, gums, ears and eyes.
As it is highly infectious, patients have to be isolated and treated. Medical workers handling Ebola patients are also required to wear full personal protective equipment, adhere to strict hygiene protocols, and handle dead bodies safely to avoid infection.
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While the disease itself is a huge challenge for the continent, this is compounded by other stumbling blocks, experts say, including traditional beliefs, witchcraft, and conspiracy theories that often impede Ebola treatment and control.
In Uganda, the Ministry of Health said the nurse who died last month had visited a traditional healer. His relatives also reportedly attempted to exhume his body to rebury it in accordance with Muslim faith dictates. However, this poses serious risks as bodies can still be infectious for a period after death.
Men carry a stretcher used for suspected Ebola victims back to an ambulance after washing it, in the town of Kassanda in Uganda on November 1, 2022 [File: Hajarah Nalwadda/AP Photo]When a friend of Kayiwa’s contracted Ebola in 2022 before he did, they believed he had been bewitched, and their first option was to take him to traditional healers. They also thought he was suffering from an illness known locally as “Ettalo”, which causes unexplained pain, and tried local herbal medicine to cure it.
Deeper conspiracy theories also prevailed during the 2022 outbreak, which started in Mubende District, an area about 160km (100 miles) from Kampala famous for artisanal gold mining.
“When we first heard about the outbreak, it was linked to the Kassanda-Mubende gold mines,” Kayiwa says. “Many people, including myself, thought it was a plot by officials to drive out the artisanal miners and take over the mining areas.”
Lack of communicationThe current outbreak, however, has come with new challenges.
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Key among them appears to be a lack of clear communication from government authorities about the outbreak; pushback from businesses, especially in the tourism sector, who argue that the way the outbreak was announced hurts the industry; and hesitancy among some people exposed to the virus to accept a new vaccine, which has been offered for trial.
At an event to officially launch the vaccine trial last Monday, Dr Daniel Kyabayinze, the director of public health at the Ministry of Health in Uganda, along with other officials, including representatives from the WHO, would not provide details on the Ebola outbreak.
Kyabayinze said authorities “are going to be releasing the status of the outbreak in a format that is separate from the vaccination process”. He argued that discussing Ebola status updates alongside the vaccine trial would lead to a “mix-up [of] messages”, which he deemed inappropriate.
Officials said the minister of health would hold a media event later that day to give an update. But that did not happen.
Emmanuel Ainebyona, a Health Ministry spokesperson, said he had no status update to share and referred Al Jazeera to high-ranking officials in the ministry. The officials did not answer repeated phone calls.
Since the outbreak was announced, the government has provided no further communication. Minister of Health Jane Ruth Aceng told journalists on Wednesday that updates would be given fortnightly rather than daily.
“Don’t ask us for case numbers every day – that is not important. What is important is that you go to the communities, tell them they need to protect themselves, and ensure they pass on information,” she said.
Without providing specifics, she added: “The update is that we have Ebola cases in the country. They are receiving treatment and improving.”
During the 2022 Ebola outbreak, people waited for food distribution from trucks, as many people were affected by travel restrictions that curtailed their business activities and livelihoods [File: Hajarah Nalwadda/AP Photo]Pushback from tourism sectorFrom the onset, the way the current outbreak was communicated elicited sharp criticism from Uganda’s tourism industry.
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Amos Wekesa, a prominent businessman in the tourism sector, posted on X criticising the government for poor strategic communication and arguing that the Ebola outbreak story had been widely covered by international media, leading to travel advisories being issued against Uganda. Countries including the United States, United Kingdom and Mauritius urged their citizens to take precautions while travelling to the country.
“Many countries might target Ugandans,” he said, adding that life was continuing as normal in Kampala.
“There will never be a disease outbreak or any attack that will ever kill more Ugandans than poverty, ” he said in a separate post on X.
Martin Mugara, Uganda’s junior minister for tourism, said on a local radio station last Saturday, “I was a bit shocked that they communicated the way they did,” referring to the Ministry of Health’s announcement of the Ebola outbreak.
Muhereza Kyamutetera, CEO of the Uganda Tourism Association, said in an interview that there is a need for “coordinated conversation and communication” before announcing health outbreaks.
“The moment news of an epidemic outbreak goes public, the next day, tour companies start receiving emails for cancellations and refund requests,” Kyamutetera said. He explained that the Ebola outbreak would affect the tourism sector for the entire year and, combined with previous incidents, affect the country’s reputation as a travel destination for years to come.
“The reputation of the destination is the most important thing,” he said. He added that many international travellers may not be aware of Uganda’s experience in handling Ebola outbreaks.
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Though at first hesitant to wade into what he described as a controversial debate, Kyabayinze, the director of public health, told Al Jazeera last week that international health regulations require every country to report any outbreak of a disease that poses a significant threat to the global community as per WHO requirements.
“Uganda announcing the outbreak was critical and important and I think we did the right thing,” he said. However, he hastened to add they “don’t want to disrupt travel, trade and tourism”.
A health worker prepares to administer a vaccine against the Sudan strain of Ebola during a trial, at Mulago Referral Hospital, in Kampala, on February 3, 2025 [Hajarah Nalwadda/AP Photo]Vaccine hesitancyThe WHO praised the speed at which Uganda was able to launch a randomised vaccine trial during an emergency Ebola outbreak last week.
In a statement, the organisation said the trial, which began in Uganda just four days after the outbreak was confirmed, is the first-ever one to assess the clinical efficacy of a vaccine against Ebola disease caused by the Sudan virus.
Despite more than half of the identified contacts of the first Ebola fatality being health workers and patients from the national referral hospital, only one person received the trial vaccine last Monday. The trial itself was being conducted at the same referral hospital.
An official involved in the vaccination process told Al Jazeera that one contact who had initially agreed to receive the trial vaccine later changed his mind. There were hopes that the individual could still be convinced to take the vaccine without media presence.
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Dr Bruce Kirenga, principal of Makerere University College of Health Sciences and executive director of the Makerere University Lung Institute, who is leading the vaccine trials, acknowledged that vaccine hesitancy remains a challenge.
“My job is to remove this hesitancy. I did it for COVID, and I will do it now,” he said.
“What causes hesitancy is a lack of information. We are going to provide people with the information they need, and they will understand the importance of participating,” he added.
What can be done better?
Freddie Ssengooba, a public health professor at Makerere School of Public Health, said while the competence of the government to handle the epidemic is not in question, the public deserves more information, especially on measures and how they should behave.
“There is an information gap, we are all anxious to know what is happening.”
Meanwhile, survivors of previous Ebola outbreaks urge people to be cautious and not to believe in rumours or conspiracy theories that could put their lives and communities at risk.
During the time Kayiwa was in hospital in 2022, he says he witnessed many deaths, and the trauma of that stays with him.
“In the first room where I was first admitted, all the patients died,” he says. “Ebola is no joke.”
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