It seems like a normal day in Mubende, central Uganda. Shops remain open, children are at school and public gatherings are allowed, provided people remain socially distant.
The ambulances that whisk past every few hours and the health workers who wash themselves meticulously before they return home are the only indications that it is not business as usual in the densely populated mining district, which is struggling to contain an outbreak of Ebola.
Twenty-nine people, including four health workers, have died since the outbreak was declared in the district on 20 September, the World Health Organization (WHO) confirmed on Wednesday.
Among them was Mohammed Ali, a 37-year-old Tanzanian doctor who was working at Mubende hospital and had operated on a patient who later tested positive for the virus. Six more health workers have been infected, bringing the total number of reported cases to 63 across five sub-counties.
“We are scared but there is nothing we can do,” said Kesande Pamela, who runs a shop in Mubende town centre. “I must keep my shop open and make money. We have information and we are trying to keep safe. We are hoping for the best.”
On Wednesday, Yoweri Museveni, the country’s president, told Ugandans that the outbreak was under control. “The government has the capacity to control this outbreak as we have done before. Therefore, there is no need for anxiety, panic, restriction of movement or unnecessary closure of public places,” he said in a televised address.
However, Dr Christopher Mambula, programme manager for Médecins Sans Frontières (MSF) in Uganda, said the situation was “very serious”. Cases were rising daily and it was still unclear how widely the virus had spread, he said, adding that the lack of a vaccine to treat the strain of Ebola responsible for the outbreak – the Sudan virus – was a concern.
Vaccines used to successfully curb recent Ebola outbreaks in the Democratic Republic of the Congo (DRC) are not effective against the Sudan virus. The WHO said several vaccines were in various stages of development, two of which could begin clinical trials in Uganda in the coming weeks.
“In terms of the contacts and the spread, if you have spread in five [regions], or more than one place, it begs the question what is the chain of transmission between those different cases, is it one person who went on to contaminate other people or was it that there was something like a super-spreader event, like a funeral, where not just one person got contaminated but several,” said Mambula.
“Until we get the indication otherwise, I would say this is very serious,” he said. “The reality is especially when you look at the incubation period, which is generally up to three weeks, it’s possible to go a week without seeing a case then suddenly 50 cases come up in one day.
“It’s still very early days and it looks like it’s increasing and not decreasing. As of today, there’s nothing to say it’s in control.”
Health workers have also said they are concerned the disease could spread to refugee camps. Mubende, about three hours’ drive from the capital, Kampala, lies along a highway to DRC. Along this route are several refugee settlements, housing at least 200,000 of Uganda’s 1.5 million refugees.
The WHO has given $2m from its emergency fund and is sending “additional specialists, supplies, and resources” to help Uganda’s Ministry of Health contain the virus, which is spread through contact with blood and body fluids. MSF has established a treatment unit in Mubende hospital and plans to open another in nearby Madudu sub-county, the centre of the outbreak.
The health minister, Jane Ruth Aceng, called this week for more international support. “The efforts made so far are important but need to be intensified if we are to end this epidemic today,” she said. “I count on all of you to mobilise more resources in your respective capacities to end the Ebola pandemic in our country.”
The Africa Centres for Disease Control and Prevention, part of the African Union, said Uganda would host a ministerial meeting next week with neighbouring states and other African countries that had experienced Ebola outbreaks to explore ways of managing them.
This is the first outbreak of the Sudan strain of Ebola in Uganda since 2012. The country is still battling the after-effects of the Covid pandemic, which saw schools close for nearly two years.
