What can we learn from Uganda on fighting deadly disease outbreaks?

On September 20^th, 2017, a young hunter, in his 30s, arrived at a health center in Kween District, located in Eastern Uganda, on the border with Kenya. He had symptoms of fever, bleeding, diarrhea, and vomiting. Within 5 days he was dead. Two weeks later, his sister also showed up at the same health facility: she had similar symptoms. Within a week, she too was dead. Posthumous samples confirmed that she had Marburg Virus Disease (MVD), one of the most virulent pathogens known to infect humans. On 19^th October, the Ugandan government notified WHO and publicly announced an outbreak of MVD. Not long after this announcement, MVD claimed another victim – this time, the hunter’s brother.

The Government of Uganda and partners on the ground responded quickly and were able to diagnose the first case rapidly, trace contacts and place suspected cases in isolation units. Communities were sensitized and trained health workers were quickly deployed. To date, the MVD has successfully been contained the outbreak within Uganda and across the border to Kenya by coordinating closely with the Government of Kenya and other partners.  Coincidentally, amidst this outbreak, the government of Uganda was gearing up for the 4^th High Level Ministerial Meeting of the Global Health Security Agenda (GHSA).  
Four key issues were raised:

• Accelerate global commitment to strengthening pandemic preparedness and response: The Ebola outbreak in West Africa has propelled important achievements in health security. Notable among these are (i) the GHSA, a multisectoral partnership of over 60 countries, international organizations and non-state stakeholders including the private sector. It was launched in 2014 as a worldwide effort to help build countries capacity to address human and animal infectious disease threats and make global health security a national and global priority; and (ii) rolling out the WHO Joint External Evaluation (JEE), which provides an opportunity for countries to assess their capacities in 19 technical areas. Since its launch in 2016, the JEE has been implemented in over 60 countries; however, prioritizing JEE recommendations into national pandemic preparedness plans and incorporating financing gaps into national budgets remain a challenge for many countries.
• Financial sustainability remains a challenge given other competing priorities and fiscal space constraints: A severe pandemic and even smaller disease outbreaks that spread can cause many deaths and cause severe economic damage. The World Bank estimates that the annual global cost of a moderately severe to severe pandemics is roughly $570 billion or 0.7% of global income. Despite what we know, investments in pandemic preparedness remain suboptimal because of competing priorities and fiscal space constraints. However, the cost of investing in preparedness is much lower relative to the devastating loss of lives, social disruptions and economic impact of a pandemic. To support countries on sustainable financing, the Bank in collaboration with the Government of Australia and WHO have developed a Health Security Financing Assessment Tool (HSFAT). The tool is intended to help identify funding gaps at the national level, and support countries to include financing of pandemic preparedness and response in their domestic budgets and develop a roadmap for sustained financing.
• Mainstreaming pandemic preparedness and response within the broader context of health systems strengthening and UHC: To achieve and sustain UHC gains requires resilient health systems that are better prepared and can recover from public health crises. Pandemic preparedness protects people from health threats and UHC reforms ensure that everyone has access to quality health services without suffering financial hardship.  Both are, therefore, mutually reinforcing in building resilient health systems. Investing in preparedness for disease outbreaks and pandemics is also necessary to contain antimicrobial resistance (AMR) when antimicrobial drugs can no longer treat the infections. UHC and global health security are both critical to achieving WBG’s twin goals of ending poverty and boosting shared prosperity as well as contributing to achieving the Sustainable Development Goals. 
• The private sector is an integral partner on the health security agenda, yet its potential has largely been untapped:  The private sector has comparative advantage in areas that are critical for pandemic preparedness and response. Through consortia like the GHSA Private Sector Roundtable, the World Economic Forum’s Epidemics Readiness Accelerator, and the Coalition for Epidemic Preparedness Innovations, the private sector is joining forces with the public sector and civil society—to find innovative solutions for addressing gaps in pandemic preparedness and response. For example, through digital data, financial services, supply chain management, communications, use of technology, and research and development of new vaccines and new antimicrobials.

What do we learn from this recent MVD outbreak in Uganda?  First, despite its limited resources, Uganda has demonstrated leadership and commitment and invested in strengthening its health system and essential public health functions including:(i) an epidemic management structure with multidisciplinary expertise with standing taskforces at the national and district levels; (ii) strong surveillance capacity, (iii) robust laboratory network; and (iv) trained disease response workforce and village health teams that can be deployed quickly. Perhaps most significant in its approach is Uganda’s ring-fenced surveillance budget, which also includes a contingency fund for responding to disease outbreaks. As we consider the future, it is important that we ensure sustained financing for pandemic preparedness and response action plans, ensure adequate institutional arrangements, leverage synergies with priorities like UHC, foster multisectoral collaboration, tap into the strengths of the private sector, and continue learning from countries like Uganda.

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Pandemic Emergency Financing Facility