KAMPALA, 25 March 2021– Health Minister Aceng has assured ths country of the safety of the AstraZenecca Vaccine against Covid-19. Below is her address in full.
Today marks exactly one year and four days since Uganda registered the first COVID-19 case. It has been a year of achievements, challenges and tribulations. Fellow Ugandans, “this far the Lord has brought us”. (1Samuel 7:12). We thank God and give him the glory. Allow me to say a big Congratulations to all Ugandans, a heartfelt congratulation to all the health workers and a special tribute to H.E the President whose able leadership has enabled us to respond effectively to this pandemic.
One year later, we are here to talk about the journey and how far we have come as a country.
Before I proceed, let us observe a moment of silence for the 334 lives we have lost to COVID-19 to date. May their souls rest in eternal peace. We must also remember, pray and pay our respect to the over 2.7 million people who have succumbed to this disease.
To put things in perspective, allow me to remind you that before the declaration of the outbreak of COVID-19 in China on 31st December 2019, the Government of Uganda was responding to an Ebola threat from the Democratic Republic of Congo (DRC). This had been going on for two years. Our Health workers were carrying out surveillance for Ebola Virus Disease at Entebbe International Airport and other inland border points of Entry. Therefore, when COVID-19 broke out, we were relatively prepared and redirected, broadened and intensified surveillance and all pillars of response to control the COVID 19 pandemic.
As the pandemic ravaged the world, we began our response by categorizing countries of incoming travelers based on risk in their countries; high risk, moderate risk and low risk.
As you may recall, the index case of COVID-19 in Uganda, was a 36-year-old male who arrived in the country from the United Arab Emirates on 21st March 2020. At that time UAE was categorized as low risk. He was detected by our Integrated Disease Surveillance and Response (IDSR) systems implemented by our vigilant health workers who raised the red flag when his temperature was above normal. He was evacuated to Entebbe Regional Referral Hospital, a nasal sample taken from him and tested at the Uganda Virus Research Institute (UVRI). The test was positive for SARS- CoV-2. This was the beginning of the pandemic in Uganda.
Overtime, a few positive, but asymptomatic travelers integrated into the communities undetected. The second challenge was that of the truck drivers. Uganda being a transit country, we had running battles with untested truck drivers who for purposes of their welfare need services from the communities along the truck routes. This was also a vehicle for transmission which led to sporadic case in the communities. This challenge was addressed when the Presidents of the East African countries resolved that each country should ensure their truck drivers are tested prior to travelling and results shared on an online system for all to view. The third challenge was that of the general Elections (Presidential and Parliamentary Elections). We had hoped that with strict measures Ugandans would adhere to the SoPs. This did not happen and during the campaigns the country progressed to phase four of the pandemic (Full blown community transmission). As the outbreak kept on spreading, we changed strategy, from preventing importation of cases to suppression of transmission within the country.
H.E The President, Yoweri Kaguta Museveni who has always supported, guided and educated the public during the several outbreaks Uganda has had, strengthened the response interventions, by declaring COVID-19 a national emergency on 18th March 2020. He issued 35 guidelines on preventive measures to help suppress the spread of COVID-19 in the country. Since then several of the measures have been lifted, but some still remain to date.
At this juncture, let me highlight some of Uganda’s outstanding achievements on the COVID-19 response:
H E the President constituted a National Task force to guide and ensure a multi-sectoral response. He has addressed the nation on COVID 19 over 20 times and continues to give guidance to date. He encouraged and promoted local manufacturing of the Protective wear and sanitizers in country which reduced on access challenges and lead time. He promoted and financed research into therapeutics and vaccines and continues to reach out to the population to remind them to get vaccinated and follow the SoPs.
2)Preparedness and Response Plans
The Ministry of Health prepared a COVID-19 National Preparedness and Response Plan that has successfully guided out activities up to today. Under this plan, we designed and developed intervention, guidelines and SOPs that have ensured a coordinated and uniform effort throughout the country.
Use of science to inform and guide interventions
COVID 19 being a new disease with varied information and evidence, the Ministry of Health constituted a Scientific Advisory Committee and Vaccine Advisory Committee, a team of eminent scientists to advise the NTF and the Ministry of Health on evidence-based interventions to guide the national response and vaccination against COVID-19. The committees consist of Senior Physicians, Public Health, Laboratory and Policy Experts, among others. Since then, the committees have provided guidance on measures such as instituting and lifting of the lockdown, isolation and treatment of patients, surveillance, change of interventions and vaccination. Three surveys have been conducted to enable us understand the spread of COVID-19 in the country, identify high risk groups and design the best possible interventions.
Decentralisation of the response
Uganda’s decentralized governance system provided a great environment for involvement and participation of local government leaders, districts, sub-counties in the response. Patient care was cascaded up to family and individual levels. This arrangement enabled the NTF and the Ministry of Health to main the roles of policy, strategy and oversight support in the implementation of the activities.
Deployment of experienced human resource
Relying on our diverse and experienced human resources the Ministry of Health with support from the Health Service Commission rapidly recruited and deployed health workers of all categories and disciplines to provided surge capacity to National and Regional Referral Hospitals to ably handle the increased number of patients. Over 3,500 health workers were trained and engaged including Intensive Care Specialists, Anaetheologists, Nurses, and laboratory technicians.
Strong surveillance system
Over the years the Ministry of Health with support from partners has built a strong surveillance system country wide up to the level of the village health teams. This system has now been extended to cover port health. We were therefore able to screen internally and at the points of entry and pick any suspected cases for quick management.
Expanded laboratory testing services
Our expanded laboratory testing and increased capacity spread throughout the country at sub national and district levels have been very instrumental in the current response. We leveraged on the existing hub system to transport COVID-19 samples from the districts to UVRI or Central Public Health Laboratory (CPHL) with quick turnaround time of results. To-date, we have 21 accredited laboratories that carry out COVID-19 tests and over 120 sample collection sites across the country. The UVRI, an award winning reference laboratory for Africa and recognized by the WHO, has been able to harmonize protocols and carry out quality checks on all the laboratories. UVRI is also carrying out genomic sequencing for variants that are now appearing due to viral mutations.
Adoption of ICT solutions
Country wide surveillance and contact tracing is supported by a digital application known as the Open Data Tool Kit (ODK) for quick collection and relaying of data to the Emergency operations center for action. Dispatch of laboratory results to all the Districts Health Officers is done through an on line Results Dispatch System. Only those with access rights can access this system. Logistics needed for the response are also tracked using an online tracking systems. The Ministry of Health established 5 call centres that responded to public inquiries on COVID-19 by providing timely information. Following a resolution by the East African Heads of State, a mobile application the Regional Electronic Cargo and Driver Tracking System was developed to help control importation and exportation of COVID 19 from one country to another.
Continuity of Essential Medical services
It is obvious that the response to COVID 19 and the control measures affected essential services and measures had to be taken to address this. The Ministry of Health developed guidelines on continuity of essential services and disseminated this countrywide. Health workers were advised to continue providing timely and quality services to the population as those selected and trained to work in the various COVID19 response pillars offered COVID 19 services
Community involvement and participation
The compliance and willingness of communities to participate in the response to COVID-19 is commendable. We have witnessed and benefitted from this outstanding community vigilance. For instance, our call centre would be flooded with calls from various parts of the country reporting anyone with suspected COVID-19 symptoms thus enabling our teams to respond on time.
At the peak of the first wave, treatment for confirmed cases was rolled over to the communities, so was surveillance through the community engagement strategy which was launched in several districts. To date over 25,000 confirmed cases were managed at home under home based care attended to by village health teams and families who were oriented and empowered to report in the event that a patient changed condition
The Media, Constant and correct communication
The media have been our dependable partners in this response, passing on timely information on prevention, control measures and progress on the response to the population thereby making a commendable contribution. Right from the beginning, we kept the communities informed about all the developments on COVID-19. The Ministers, Director General, Permanent Secretary, Incident Commander, and Public relations officers were provided with up-to-date information on a regular basis and were able to pass it on whenever required.
We utilized all possible communication channels such as mass media, digital/social media, print media, telephones, community radios and megaphones, to communicate to the population. This enabled us to maintain the trust and confidence that the population has in the response.
Surveys to assess the COVID-19 situation and guide the response
To-date, we have conducted 2 Rapid Assessment Surveys (RAS) to identify the risk groups, their demographic and socio-economic characteristics, and the magnitude of the disease within the communities. The Ministry of Health is currently carrying out the third survey – ‘a population based sero-survey’ to establish the extent and prevalence of COVID-19 in Uganda.
Strong partnerships and collaborations
We continue to enjoy a strong and mutually beneficial relationship and collaboration with our donors and technical partners. Their financial, human, logistical and technical support has made our response to the pandemic effective and timely.
Donations from the population
During one of his addresses, H E the President called upon the public to donate and support the COVID-19 response. The Ministry of Health was overwhelmed by the positive feedback and response from the population. Individuals from all walks of life contributed in-kind, supplies, food, vehicles, cash and technical support to the pandemic. I wish to appreciate the private sector, the business community and the entire population for this rare display of patriotism and compassion.
Out of all these efforts, contributions and support, Uganda has made a mark on the global scene as far as response to this pandemic is concerned. This is evidenced by a recent study published in the Lancet Medical Journal released during the 75th Session of the United Nations General Assembly by the Lancet COVID-19 Commission of Experts who listed Uganda among the 10 best countries in responding to the COVID 19 pandemic globally and the best in Africa.
There is no public intervention that is not faced with challenges. Similarly, the Ugandan response has been faced with several challenges
The Global shortage of testing kits; This affected the response and led to delays in sample collection, testing and issuing of results. Uganda responded to this challenge by placing of frequent orders albeit small. Several partners also came in to support notably WHO, UNICEF, the Global Fund and others. In addition, the WHO has now prequalified antigen Rapid diagnostic test kits for use this will go a long way in supporting the response. Antibody test kits have also been prequalified for surveillance and is currently being used for the ongoing sero-survey. Ugandan scientists from Makerere University have also developed and launched our own antibody test kits which we are using for surveillance.
Access to Personal Protective Equipment was yet another huge challenge. We were relying on imports of PPE and often had to compete with other rich countries for the limited supplies. In regards to this challenge, H.E. the President encouraged and supported local manufacturers to re-focus their production on PPEs for our health workers. To date; coveralls, gumboots, aprons, medical masks, sanitizers are all available in adequate quantities in Uganda. We no longer have to rely on imports.
Protracted response and fatigue; A full year of restricted social interactions has affected many people including our frontline health workers who cannot go home to see their families.
There is fatigue, economic challenges and burnout. The sooner the pandemic is brought under control the better.
Financial challenges; the response to COVID19 has been one of the most expensive to run. Measures to control COVID 19, shuts down economic activities, affect revenue collection and runs down economies. While the response itself requires more human resources, test kits, PPEs, intensive care units, Ambulances, vehicles, more admission facilities etc.
Wrong and discouraging Social media messages; A lot of time and money is spent responding to wrong and falsified messages meant to discourage the populations and cause them to become complacent.
Changing scientific evidence; COVID 19 being new, not much is known about it. Scientists had to conduct rapid research in the shortest time possible, therefore information kept on changing. This affected the response and sometimes led to mistrust from the population.
UPDATE ON THE COVID VACCINATION IN UGANDA
Uganda received her first batch of COVID-19 AstraZenecca vaccines on the 5th March 2021 and vaccination was launched by the Right Honorable First Deputy Prime Minister on Wednesday 10th March 2021 at Mulago Specialized Women’s and Neonatal Hospital. We thank the COVAX facility and the Government of India for enabling Uganda to access the initial 964,000 doses of the AstraZeneca vaccine. So far, a total of 663,520 doses have been distributed to all districts in the country. Vaccination against COVID-19 commenced with all healthcare workers in the country. To-date 32,526, people have received their 1st dose of the COVID-19 vaccine.
We are going to cascade this vaccination until the entire population is covered to prevent severe disease and death. The Ministry is currently vaccinating health workers, teachers, and people aged 70 years and above concurrently against COVID-19. Vaccination is taking place at designated public health facilities which include health center IIIs, IVs, General Hospitals, Regional Referral Hospitals and National Referral Hospitals.
COVID-19 AstraZeneca Vaccine and Safety Concerns
The WHO Global Advisory Committee on Vaccine Safety (GACVS) reviewed all available information and data on thromboembolic events (blood clots) and thrombocytopenia (low platelets) after vaccination with the AstraZeneca COVID-19 vaccine.
The GACVS COVID-19 subcommittee also reviewed clinical trial data and reports based on safety data from Europe, the United Kingdom, India, and Vigibase, the WHO global database of individual case safety reports.
Based on a careful scientific review of the available information, the subcommittee came to the following conclusions and recommendations (released on 19 March 2021):
The AstraZeneca COVID-19 vaccine continues to have a positive benefit-risk profile, with tremendous potential to prevent infections and reduce deaths across the world.
The available data do not suggest any overall increase in clotting conditions such as deep venous thrombosis or pulmonary embolism following administration of COVID-19 vaccines.
The WHO advises that countries should consider continuing to roll out the AstraZeneca vaccine, while ensuring that they continue to monitor the safety of all COVID-19 vaccine events through effective surveillance systems and promote reporting and follow-up of any suspected adverse event.
PRIVATE SECTOR INVOLVEMENT IN COVID-19 VACCINATION
The Ministry of Health has received several requests and proposals from corporate entities and the private sector to vaccinate their employees against COVID-19.
The Ministry would like to inform organizations that are interested in providing vaccines to their employees to write to the Director General Health Services requesting to import COVID-19 vaccines which are cleared by the World Health Organization (WHO) for Emergency use and approved by the National Drug Authority (NDA) for use in Uganda. The letter should indicate the number of employees and their dependents that are eligible for vaccination. Importation will be allowed through the National Medical stores for purposes of maintaining the cold chain and viability of the vaccines
Please note that the vaccines you will be importing if authorized are NOT FOR SALE but only for use within the organization.
Additionally, The Ministry of Health is in the process of accrediting private health facilities to provide COVID-19 vaccination. The list of these facilities will be provided once an understanding has been reached and a memorandum of understanding has been signed spelling out the modalities of the collaboration.
I urge all Ugandan to get vaccinated when your turn comes. No vaccine should be wasted as our lives depend on it
I would like to take this opportunity to appeal to the health workers, District Health Officers (DHOs) and the Resident District Commissioners (RDCs) to:
Take leadership of the vaccination exercise. Remember, that until everyone is vaccinated and protected, none of us is safe. It is your responsibility to ensure that the vaccination exercise at the district level takes place in a smooth manner.
Ensure that all individuals in the priority groups receive their vaccine.
The vaccination exercise should continue even on weekends.
Vaccination is voluntary and free of charge. I want to reassure the public that AstraZeneca/Oxford vaccine which we are administering is safe and effective against COVID-19. Remember, choose life NOT death.
We also MUST not abandon the scientifically proven prevention and control measures i.e.: consistently and correctly wearing masks while in public, physical distancing of at least two meters and washing hand with soap and water or use alcohol-based sanitizers.
As I conclude, I would like to appreciate all our development partners, implementing partners, MDAs, Private Sector, the United Nations Agencies, and the media for their technical and financial support towards the response to the COVID-19 pandemic.
Dr. Jane Ruth Aceng Ocero
Minister for Health.