October 26, 2022

As Ebola Cases Increase in Uganda, Questions of Global Health Equity Arise

By Ethan Walsh

Predominantly concentrated in Uganda’s Mubende district following several confirmed cases in a local community surrounding a gold mine, the country’s recent outbreak of Ebola Virus Disease (EVD) is swiftly on the rise — according to the most recently available data from the World Health Organization, 64 individuals have tested positive for EVD, 25 of whom have died. A further 20 individuals are assumed to have passed away from the disease but died before proper confirmation could be carried out. The outbreak is caused by Sudan ebolavirus (SUDV), unlike the widespread epidemic in Western Africa of the 2010s, which was due to the species Zaire ebolavirus (EBOV). Though the EVD symptoms the viral strains give rise to are identical, several issues regarding prevention and treatment distinguish the two species. The vaccine widely (and successfully) used to reduce EBOV transmission in Africa cannot be used to prevent this latest outbreak and available monoclonal antibodies for EBOV treatment do not show equivalent success with SUDV. Moreover, the symptoms individuals with EVD display are highly similar to those of other infectious diseases common in Uganda, such as malaria, impeding abilities to quickly diagnose and isolate Ebola patients. Encouragingly, the government imposed lockdown measures with clinical trials for experimental vaccines likely beginning soon. Garnering optimistic estimates, the government claims the outbreak will culminate by the end of the year.

 

In instances like these, it is worthwhile to evaluate conditions beyond virology and epidemiology — as the late medical anthropologist Paul Farmer wrote in his book detailing his experience in Liberia and Sierra Leone during the height of the West African EBOV epidemic, “the virus is never the only protagonist of the story.” In the account, Farmer wrote extensively about the brutal legacy of colonialism in Africa and how it visibly plagued every aspect of the global response to Ebola. This must not be overlooked; historically, as European powers extracted resources from African colonies, healthcare infrastructure was neglected, as were various institutions. In today’s nominally postcolonial period, the underdevelopment caused by this extraction forces African countries into dependence upon the Global North — having to accept predatory loans from Western-interested institutions like the International Monetary Fund and the World Bank that necessitate structural adjustment programs, i.e. the privatization of institutions like healthcare and the divestment of funding from public options. Unsurprisingly, this systematic dismantling of public healthcare has well-documented adverse effects on health outcomes and development more broadly. These phenomena extend to Uganda and impact its current response — vestiges of British colonialism continue to detrimentally affect the country’s medical system, in addition to general underdevelopment handicapping infrastructural capabilities.


Simply put, if patients in Uganda had access to healthcare commensurate to that in the Global North, mortality rates would be lower; that they do not is at the blame of colonialism and imperialism, at least in large part. The global response to outbreaks like these must center the lives and wellbeing of individuals in underdeveloped nations — as opposed to profits for Western pharmaceutical corporations — and fight to ameliorate the flagrant inequities caused by past (and ongoing) imperial plunder. Global health organizations must learn from the mistakes of the former Ebola epidemic and the COVID-19 pandemic, wherein African countries were continually ignored on the global stage, leading to vast disparities in vaccination rates and treatment capabilities. For a more equitable global health scenario, organizations should support these nations while also aiding them in gaining autonomy over their medical and economic conditions and developing independently, in Uganda and beyond.

 

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