Ebola is one of those diseases you’d rather not know about. It has a high mortality rate, often over 50%, and while the symptoms start with a fever and headache, in the latter stages, the body internally bleeds to death. Because it’s spread through body fluids, such as an infectious person’s blood, vomit, urine, saliva, sweat or semen, it’s not as infectious as respiratory pathogens such as Covid-19, which spread through air. Those most at risk of Ebola are healthcare workers and family members caring for their sick loved ones.
Uganda is currently battling one of its largest outbreaks of Ebola. The Ugandan outbreak is caused by the Sudan strain of the virus, for which there are no approved vaccines or treatments. This is why the new outbreak is particularly concerning public health experts. As with Covid-19, the race is now on to find an effective vaccine: there are two potential candidates from GSK and Oxford, and clinical trials are being launched in the middle of this outbreak.
The head of the World Health Organization, Tedros Adhanom Ghebreyesus, said there have already been 63 probable or confirmed Ebola cases and 29 probable or confirmed Ebola deaths. Four of those dead were health workers. Cases were first detected in the Mubende district among people living around a goldmine. Gold traders are highly mobile, particularly along the busy highway that runs between Kampala, a densely populated and globally connected capital of 1.68 million people, and the Democratic Republic of the Congo to the west. Countries have already started implementing surveillance measures; the United States has started redirecting travellers from Uganda to five US airports to screen them for the Ebola virus, and is now monitoring them for 21 days to see whether symptoms develop. Neighbouring countries like Kenya and Tanzania are on high alert.
In 2014, Ebola made global headlines. Some news agencies called it the “Isis of disease”, and a panic set in when Ebola cases were detected in Europe and North America. In 2014, “What is Ebola?’ was the most-searched question in America and Ebola was the third highest search term overall. Since 2014, it’s largely disappeared from the public imagination, at least in western countries. There have been outbreaks of Ebola in DRC, but these have largely been controlled through vaccines and other public health measures. The outbreaks in 2014 and more recently in DRC have been caused by the Zaire strain of the virus: we now have two approved vaccines against this strain and an effective monoclonal antibody treatment.
We’re all sick of viruses and diseases by now. Covid has led to fatigue, and many don’t want to hear about public health and hygiene efforts any more. Yet viruses don’t care what we feel or whether we want to hear about them. The history of humanity is one of various germs trying to kill us, and our efforts to stay ahead of them using science and data. There is clear survival bias that shapes our thinking about the Covid pandemic. It’s easy to look back in a post-vaccine era and say it wasn’t so bad, especially because we’re surrounded by those who were infected and lived. Those who died don’t have a voice.
The Ugandan health secretary, Jane Aceng, has said that local people initially thought the new Ebola outbreak was caused by witchcraft, so didn’t seek medical care. It took government intervention to create a broader understanding that the disease was caused by the Ebola virus. Rumours, whether in person or online, can undermine health efforts in all countries, rich or poor, as demonstrated by the viral Facebook and Twitter posts that Covid is a hoax, and that vaccines are killing people.
Aceng has repeatedly called on other countries to provide funding to support Uganda’s public health workforce through adequate personal protective equipment. Health staff need single-use medical gowns, double nitrile gloves, masks, face shields, surgical hoods and long boot coverings to work safely. The health secretary has continuously raised the alarm that this disease could spread to neighbouring countries and on flights across the world. Uganda needs help. At the same time that it’s managing this Ebola outbreak, the country also faces a resurgence of malaria, tuberculosis, HIV, as well as the toll of Covid-19, all while having far less resources than western nations (30% of Ugandans live off less than $1.77 (£1.50) per person a day).
But the calls from Uganda’s health secretary have been met by silence and a sense of fatigue from leaders across the world. Even Uganda’s own president, Yoweri Museveni, said last month that there was no reason for anxiety, panic, closures or any kind of restrictions on movement. We’ve seen similar splits in Britain, whereby politicians and health experts seem to be pulling in different directions. Yet Aceng is right: if the outbreak reaches Kampala and starts spreading out to neighbouring countries, it will become harder and harder to control. We know that the most effective response is to put out the fire as soon as possible, and so the faster other countries help Uganda control this outbreak, the less likely that you’ll be reading about the first cases in Britain or Europe.
We tend to forget that across the centuries, controlling infectious diseases has been a central reason for international cooperation. This is why governments came together in 1851 at the first International Sanitary Conference, to stop the spread of cholera plague and yellow fever. Infectious diseases far afield are always only just a plane ride away. For both humanitarian and for self-interested reasons, there’s a clear imperative to stop outbreaks wherever they happen.
• This article was amended on 13 October 2022 to clarify that the figures given for Ebola cases and deaths in Uganda are a combination of probable and confirmed cases; not all have been confirmed by testing.
Prof Devi Sridhar is chair of global public health at the University of Edinburgh
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