Uganda’s President Yoweri Museveni has extended quarantine measures in the two districts at the epicentre of the country’s Ebola epidemic for another 21 days, citing the need to protect gains in the fight against the virus.

This marks the third renewal of lockdowns in Kassanda and Mubende, and authorities are hopeful it will be the last. Movement in and out of the districts was first restricted on 15 October, and renewed for another 21 days on 5 November. The measures include a curfew and the closure of social spaces like churches, bars and markets.

“It may be too early to celebrate success, but overall, I have been briefed that the picture is good,” Museveni said in a televised address delivered by vice-president Jessica Alupo. While the situation is “still fragile”, Museveni said Ugandan health authorities are “very optimistic” that the outbreak will end “in the coming month.”

The government’s optimism is buoyed by Uganda’s continued progress in stamping out the outbreak. Three districts have completed over 42 days since the last case of Ebola was detected, while six districts – including the epicentres of Kassanda and Mubende as well as the capital, Kampala – remain in “follow-up” protocols.

The virus has so far claimed 56 lives, while another 22 probable Ebola deaths were registered before the government issued its official declaration of the outbreak on 20 September.

“If we open now and a case appears, we will have destroyed all the gains we have made in this war,” Museveni said. “Our healthcare workers will continue to do all it takes to save lives and bring the epidemic to an end.”

Full reopening if the 21-day mark is reached

The government’s decision to extend lockdowns by 21 days is based on the incubation period of Ebola. The three-week mark is a key indicator of whether transmission has been stopped.

Mid-way through November, Mubende appeared to be in the clear. The district had gone 13 days without reporting a new case. But on day 14, a 23-year-old medical student with links to previous cases was diagnosed with the virus.

“Without completing 21 days, as we saw with Mubende, a case can pop up anywhere,” the President said. “It is important that we complete the entire cycle.”

Kassanda has now reached 15 days since reporting a new case, while Mubende has not registered a confirmed case for 14 days. If both districts hold on for another week, Uganda’s fifth deadly encounter with the Sudan strain of Ebola may come to a swift end.

“We are relying on you to cooperate and bring this epidemic to an end,” the President told residents of Kassanda and Mubende, noting their commitment and sacrifice thus far. “If there is no case by the end of the 21-day period, we will re-open fully.”

Threat of urban transmission avoided 

When six school children were diagnosed with Ebola in Kampala in late October, fears of the virus embedding itself in the capital spiked. 

On paper, Ebola’s mortality rate of up to 90% makes the virus easy to contain. Museveni also noted that as a virus transferred through contact and bodily fluids, Ebola, despite its “devastating nature”, is far easier to control than airborne threats like COVID-19.

But if allowed to embed itself in densely populated areas, things can quickly spiral out of control. “If we had allowed the escalation of the outbreak into Kampala, the consequences would have been bad, including possible exportation to our African brothers in neighbouring countries,” Museveni said. 

Despite calls from doctors and health advocates to lockdown the capital earlier this month, Museveni and Health Minister Jane Ruth Aceng elected not to bow to the pressure. So far, their decision appears to be validated. 

“The opportunity for immediate quarantine of contacts was lost for Mubende and Kassanda,” Museveni said, noting the first suspected cases were registered on 6 September, two weeks before authorities declared the outbreak.

This was not the case for Kampala. Knowledge of the threat allowed health authorities to be on reactive footing, and respond quickly to isolate infected people and their contacts. Today, over 300 contacts remain under institutional quarantine overseen by the Ministry of Health. 

Vaccine Trials Are Underway 

There is currently no known vaccine for the Sudan strain of Ebola responsible for the Ugandan outbreak. But the outbreak presents a unique opportunity to bridge this treatment gap, and a series of trials have been set in motion with the aim of minimizing hospitalisations and deaths. 

A coalition of organizations including CEPI, Gavi, the World Health Organization and Ugandan health authorities are deploying three vaccine candidates to about 3,000 people who have been in contact with Ebola patients. “As we speak, the government of Uganda is finalizing the regulatory approvals,” Africa CDC Director Dr Ahmed Ogwell told CNN. 

If any of the candidates can succeed, authorities are hopeful this will be the last outbreak Uganda faces without medical defenses.

“By embedding research at the heart of the outbreak response, we can achieve two goals,” the WHO said in a statement. “Evaluate potentially efficacious candidate vaccines, potentially contribute to end this outbreak, and protect populations at risk in the future.”

Image Credits: WHO, WHO, WHO.