The Ebola outbreak in Uganda has worsened significantly, and the country’s ability to contain the spread has been severely weakened by the Trump administration’s freeze on foreign assistance, American officials said this week.
The officials, representing a variety of health and security agencies, made the assessment during a meeting with U.S. Embassy staff in Kampala, the Ugandan capital, on Wednesday. An audio recording of the session was obtained by The New York Times.
There have been two more deaths, the mother and newborn sibling of a 4-year-old who died last week, an American official said. The mother and sibling died earlier than the 4-year-old, but were not identified as probable Ebola cases until after they were buried through belated contact tracing.
Eighty-two people have so far been identified as close contacts of the mother and her two children, at high risk for infection, and 68 of them are now in quarantine while the others are still being traced. The officials said public health workers’ ability to trace their contacts and conduct surveillance for new cases is severely hindered without U.S. assistance.
Two of the contacts are already symptomatic and have been admitted to an isolation hospital ward, an American official in Uganda said in the meeting. The 4-year-old was taken for treatment at four different health facilities before being diagnosed with Ebola, meaning that many of those who have potentially been exposed to the virus are health care workers.
During the meeting Wednesday, American officials said that the Ugandan government also lacked sufficient laboratory supplies, diagnostic equipment and protective gear for medical workers and people tracing contacts. The termination of grants from the U.S. Agency for International Development was impeding the ability to procure those supplies, one official said. The meeting, conducted by video, was attended by representatives from the State Department, U.S.A.I.D., the Defense Department, the U.S. Embassy in Uganda and the Centers for Disease Control and Prevention.
Asked for comment on the concerns expressed in the meeting, a State Department spokesperson sent an email saying that the U.S. government was working with Uganda and other partners “to rapidly contain this outbreak and identify evolving needs.” The collaboration of both governments, the statement said, “has thus far minimized the impact of this outbreak on U.S. citizens.
The outbreak has been caused by a strain of the Ebola virus for which there are no approved vaccines or treatments. So far, it has caused four deaths, 12 confirmed cases and two suspected infections. Public health experts say it could get much worse without adequate resources to control it.
The Africa Centers for Disease Control said on Thursday that there were five cases in the cluster that includes the 4-year-old, three confirmed and two probable. Although these cases were far from the original ones, genomic sequencing suggested the same virus had caused the new ones.
The outbreak was declared on Jan. 30, after the death of a 32-year-old nurse in Kampala who sought care at multiple major hospitals across the country, and also consulted a traditional healer in the eastern Mbale district.
It was the first time the first case in an outbreak has been identified in the capital, which has a population of roughly six million people, posing added challenges for containment and raising significant concerns about the virus’s potential to spread rapidly in densely populated urban areas. In the meeting. U.S. officials expressed concern that there was no investigation of nontraumatic deaths happening in Kampala to determine if more might have been caused by Ebola.
Dr. Herbert Luswata, president of the Uganda Medical Association, said that the Ebola response had been badly hampered by the absence of U.S. support and that Uganda’s health system was notably less prepared and responsive than it had been during the last Ebola outbreak, in 2022.
Dozens of medical workers enlisted to help treat patients in 2022, he said. Now, the lack of funds and shortages in protective equipment have left many afraid to help this time, especially in high-risk isolation units.
In the current outbreak, he said, “With no U.S.A.I.D. money and C.D.C. expertise, it was like Uganda was left to die.”
This week, the United Nations started an emergency appeal to raise $11.2 million to help Uganda contain the Ebola outbreak, as U.S. aid cuts strain the nation’s health budget.
On Feb. 26, Elon Musk told cabinet members that after “accidentally” canceling U.S. support for efforts to contain Ebola, his team at the Department of Government Efficiency had “restored the Ebola prevention immediately, and there was no interruption.” However, four of the five contracts for Ebola-related work were in fact cut.
Two have now been restored, an embassy staff member told his colleagues during the meeting Wednesday, but the two that have not been restored were “the bulk of U.S.A.I.D. assistance” — $1.6 million out of $2.2 million.
In the meeting, a U.S.A.I.D. staff member introduced himself by saying that he had taken over the emergency outbreak file after his predecessor was put on administrative leave. He said: “Our intent is to get answers on critical awards getting turned back on, we’re working on that but we don’t have any solid updates right now.”
One official expressed concern about regional disease surveillance, for which critical U.S. support was terminated last week.
“With the stop-work order and the termination of awards there is no longer programming, so the future outlook now is concerning and that is what we are hearing from regional preparedness groups,” she said.
Then another official jumped into the conversation to say there was ample reason for concern given the region’s other disease outbreaks — including one of Marburg disease, another viral hemorrhagic fever — and its significant movement of people across land borders.
None of the cases in the new cluster of Ebola infections and deaths had been identified as contacts from the original cases, highlighting the weakness of the current surveillance system.
From the onset, the declaration of this Ebola outbreak has rattled medical workers nationwide.
At the Mbale Regional Referral Hospital, where the nurse in the first identified case had sought medical attention, doctors complained about the scarcity of supplies to reduce the risk of exposure and transmission, including masks, hand sanitizers, gloves, face shields and thermometers. Many refused to attend to patients until they got much-needed prevention materials.
There were no funds for at least two days to deploy a surveillance system or do effective contact tracing at Mbale, according to two doctors working at the hospital who requested anonymity because the government asked medical staff not to speak with the press.
Although there are no approved vaccines for this Ebola strain, two experimental vaccines have been deployed in Uganda, and more than 250 contacts of people infected have been vaccinated.
But even as they strive to contain the outbreak, health officials have hesitated to impose severe restrictions because of lingering anger from measures put in place during the Covid pandemic. Tourism officials have also urged the government not to restrict travel for fear that it would decimate jobs.
Misinformation about Ebola persists among the public, with many viewing the outbreak as a tactic to secure foreign aid or consolidate the ruling party’s grip as election season gets underway. Doctors in Kampala have also criticized the country’s health ministry and its partners for being less transparent with information during this Ebola outbreak compared with previous ones.
Uganda’s government has dismissed accusations that its Ebola response efforts have been hindered, calling them “unfounded.” Henry Kyobe Bosa, an epidemiologist overseeing the health ministry’s Ebola response, said the authorities had swiftly detected cases, identified contacts and placed them in quarantine. Additionally, close contacts were added to no-fly lists to prevent them from leaving the country, he said.
“We worked overdrive,” Mr. Bosa said in an interview. “We got it right at the very beginning.”