According to the World Health Organization (WHO), there have been 74,260 confirmed cases of COVID-19 and 752 deaths in Uganda in the period from January 3 to June 24. This means that the number of Covid-19 deaths has seen a 10-fold increase since the first case of Covid-19 was confirmed in Uganda in March 2020. At the same time, a total of 935,184 vaccine doses were administered as of June 23. In other words, less than 2% of the population of 44 million has received at least one dose of a coronavirus vaccine, in spite of vaccination being seen as the only hope to protect populations. Obstacles to access to the vaccines for poor countries like Uganda remain, although public funds were dispatched last year for buying enough doses.
The most unfortunate part of the current situation is that the Covid-19 situation in Uganda has turned into a blame game, while people on the sidelines are dying. While the government blames the people for not adhering to official Covid-19 guidelines, Ugandans are angry because of the mismanagement of the resources allocated to the pandemic response. Although there is a very concrete need to work on this together, the back and forth between the people and the government continues.
Vaccine procurement: delayed by the West
There have been efforts in Uganda to acquire vaccines that would help improve the pandemic response. However, the challenges that culminated in mistrust towards the government started with the first announcement of the exorbitant pricing per dosage that pharmaceutical companies were charging, which Ugandans equated to theft by either their government or the brokers supporting the process of acquisition of the vaccines.
News that Uganda would be paying USD $7 per dose for its 18 million dose order of the AstraZeneca vaccine – a price that is 20% more than South Africa and roughly triple that being paid by the European Union – sparked anger and outrage around global medicines access advocates – and on social media channels.
During an interview for Health Policy Watch, Alfred Driwale, the manager of the Uganda National Expanded Programme on Immunization (UNEPI) at the Ministry of Health, stated, “You cannot compare prices directly between countries because there are many factors to consider. Prices have to vary anyway.” This is a position that we think needs to change amongst our leaders in Sub-Saharan Africa. Many activists on social media platforms have argued against this position. Social justice advocate Allana Kembabazi commented on Twitter that this is unjust and unfair, noting that “Bilateral deals between wealthier countries and companies mean low-income countries like Uganda get a raw deal with price hikes.”
Amid all the challenges of pricing and scarcity, the vaccines that have been purchased have not yet reached the country. The few doses that have been administered were donations, and this has only escalated the mistrust. Government officials have focused on explaining the delays through the lens of international power relations. The Housing minister, Chris Baryomunsi, who is also an epidemiologist, told The Guardian, “The problem has been the supply side; we have the money but we simply can’t get the vaccine. This is a challenge of access and equity. We have to rely on the western world and the western world has focused on its population. The impression is that people there don’t care about Africans.”
Uganda, which successfully repressed earlier waves of infection has, like other countries across Africa, risked significant economic damage by imposing another severe lockdown to try and reduce the current rising death rates due to the aggressiveness of the latest wave.
This has caused a widespread feeling of panic and abandonment since the country’s leadership has adopted a militarized response to the lockdown, access to medicines and food, and many people have turned to faith for protection.
The MoH has admitted that they are overwhelmed, and they have not done enough to protect the vulnerable. The private sector has taken advantage of the situation, taking all possible steps to secure a profit on the pandemic. Civil society organizations in Uganda, including the People’s Health Movement (PHM), have repeatedly demanded that their role in the pandemic response should get properly regulated.
Unfortunately, the warnings have not been taken up seriously. Today the private sector is profiteering from the health situation by charging the public exorbitant fees for care, which average citizens cannot afford. Because of that, people have turned to alternative means of care like self-medication, the advice of social media doctors like Dr. Paul Kasenene, and herbal and traditional medicines.
Problems have been encountered everywhere from securing enough beds for patients to procuring enough oxygen tanks. Government hospitals do not have enough beds for the critically ill patients, whereas private hospitals are too expensive for most. Although the government has put in place a National Scale up of Medical Oxygen Implementation Plan 2018-2022, this was not enough to salvage the situation and avert the oxygen crisis.
Uganda has the capacity to fill 3,000 oxygen cylinders per day, but this is far below what has been needed since the latest surge in Covid-19 cases. According to doctors in Kampala, the need for oxygen has risen to almost 25,000 cylinders a day. Each of the 14 big government hospitals in Uganda has an oxygen generating plant and they provide cylinders to smaller hospitals and clinics, but they are struggling to meet the increased demand. There’s also a shortage of cylinders to go around, the doctors warned — meaning the oxygen plants have to ship the ones they have back and forth to be refilled, and that doesn’t happen quickly.
As Leith Greenslade, the coordinator of Every Breath Counts Coalition, rightly told NPR, “If you don’t have oxygen and you don’t have a vaccine, this is like a perfect storm for mass fatality.” Uganda needs support from donors to be able to curb the spread of COVID-19 else more people will die due to the dilapidated health system. The citizens also need to demand that the government, as the one responsible for securing the right to health for everyone, does everything in their power to rebuild and strengthen the health system so that it works for all, regardless of social status. In the event of donations as a support mechanism, the citizens need to put the government to account to both the donors and the citizens, so that the donations are used in the best interest of the people. All in all, COVID-19 will continue to kill people in Africa until there is global and genuine support to end the pandemic.
Denis Bukenya is a lawyer and health activist and a member of PHM Uganda working with the Human Rights Research Documentation Centre (HURIC).