On July 30, a Friday, Uganda’s President Yoweri Museveni partially lifted the 42-day lockdown order that had been implemented in June amid a surge of COVID-19 infections in the country.

Uganda’s total population is just over 45 million. The number of people in the target group prioritized for vaccination amounts to 21.9 million. At the time Museveni announced the partial lifting of the lockdown, less than 1.5% of those in that target group (only about 1.2 million) had received the recommended vaccines: According to Dr. Jane Ruth Aceng, minister of health, 902,293 had received the first jab, while only 232,742 people were fully vaccinated.

By the end of August, Uganda had only received roughly 2,025,280 vaccine doses, all donations: 1,725,280 through the COVAX scheme, as well as 300,000 Sinovac doses from China.

Uganda, however, has not effectively reached a state of suppressed transmission of the coronavirus, which would mean the positivity rate drops to 5% or below. Having reached a staggering 19.2% positivity rate as of June 8, Uganda was still experiencing 7-8% positivity by July 30—there was still active transmission happening at the community level. 

This is the reality still facing many countries around the world, especially in Africa, due to the global vaccine apartheid and forced scarcity engendered by rich countries hoarding doses and protecting the profits and intellectual property rights of pharmaceutical companies over the lives of the world’s population.

But the government had to make a hard decision, opting to relax restrictions on trade, movement, and transport because the economy was bleeding and people had nothing to eat.

“Literally speaking, if the opening up during the first wave represented a training drill under a mixture of blank and live shots, what we have loosed Ugandans onto is an actively raging battlefield,” said Dr. Misaki Wayengera, the chair of Uganda’s Scientific Advisory Committee on COVID-19 for the Ministry of Health. 

The “government of Uganda’s strategy is mass vaccination of the eligible population (22 million, representing 49.8% [of the total population]) as a means of optimal control of the pandemic and full opening up of the economy,” Dr. Aceng said.

Out of 80 million vaccine doses that the Biden administration has designated for global donations, the US government has committed to donating about 25 million doses to 49 countries in Africa. Uganda will certainly benefit from this donation, although the exact number of doses it will receive is still unknown. 

“In the next coming weeks, we’ll continue to see additional deliveries to reach this 25 million,” according to Jessica Lapenn, US ambassador to the African Union.

Dr. John Nkengasong, director of the Africa Centres for Disease Control and Prevention, said the vaccines donated by the US government will help to ensure that vaccination efforts will continue or resume in African countries that are either running out of doses or had already exhausted the doses they previously received. The fact remains, however, that only 1.7% of people in Africa have been fully immunized.

After the eighth meeting of the Emergency Committee convened by the WHO Director-General under the International Health Regulations (2005) (IHR) regarding the coronavirus disease (COVID-19), which took place on Wednesday, July 14, the committee issued a call to action to have at least 10% of all countries’ populations fully vaccinated by September 2021. 

But the WHO has warned that, at the current pace of vaccine distribution, nearly 70% of African countries will not reach the 10% vaccination target by the end of September. Ministry of Health officials in Uganda said they expect another 11 million doses to arrive in the country by September.

Without enough vaccines, the governments of poor countries like Uganda are unlikely to hit that target. They will have to make the decision to lift lockdown restrictions and play a deadly game of “hide and seek” (imposing lockdowns when surges arise and health systems become overwhelmed, then opening back up when the devastation subsides). 

This is the reality still facing many countries around the world, especially in Africa, due to the global vaccine apartheid and forced scarcity engengered by rich countries hoarding doses and protecting the profits and intellectual property rights of pharmaceutical companies over the lives of the world’s population. 

Chinese Ambassador to Uganda Zhang Lizhong talks to a worker after handing over the Sinovac COVID-19 vaccine at National Medical Stores in Entebbe, Uganda, July 31, 2021. Hajarah Nalwadda/Xinhua via Getty Images

With few or no vaccines, many countries are still at peak risk and are experiencing faster and higher surges of cases. “We must all double down on prevention measures to build on these fragile gains,” said Dr. Matshidiso Moeti, WHO regional director for Africa. 

“Vaccine inequity can fuel the epidemic through emergence of variants. It will also create social-economic impacts, particularly on education, and generate poverty—and all these will create a bad epidemic that will increase the inequity trap,” professor David Serwadda, head of the vaccine advisory committee in Uganda, told me. “We shall have a worldwide trap—if one region vaccinates and another does not …”

Vaccine inequity around the globe has resulted from a combination of factors, including rich countries hoarding vaccines, nationalist sentiments and fear overcoming global solidarity, and poorer countries relying on donations without being given a chance to purchase their own preferred vaccines (even if they are willing to purchase directly from manufacturers).

According to WHO Director-General Tedros Adhanom Ghebreyesus, one of the gravest threats and grimmest realities exposed during this pandemic has been the lack of international solidarity and sharing: the sharing of pathogen data, epidemiological information, specimens, resources, technology, and vaccines.

“What worries us is how the virus mutates, and we can only prevent it if we take this vaccine equity and implement it truly,” said Dr. Yonas Tegegn Woldemariam, WHO Representative in Uganda. 

“The problem in Africa is vaccine famine, not vaccine hesitancy,” Dr. Nkengasong recently told Reuters. “It is very unfortunate, if you recognise that we have to immunize at least up to 70% of our population. That tells you we have an incredibly long journey to go where we have to be.”

Again, as of today, less than 2% of the 1.3 billion people living on the continent have been fully vaccinated. 

Museveni worried about vaccine acquisition 

“We are struggling with buying vaccines. We are talking to everybody—most importantly, we are developing a vaccine,” President Museveni reassured Ugandans during a presidential address on Saturday, Aug. 14. 

To date, the government has only secured around 2 million vaccine doses, all in the form of donations, but authorities are looking to acquire more vaccines as richer countries immunize more of their populations. 

“We must expand our manufacturing capacity on the continent, which will help us in public health and [provide] significant economic benefits because it will create jobs and ensure that things purchased out of Africa are bought locally, which will strengthen our economies,” Dr. Ahmed Ogwell Ouma, deputy director of the Africa CDC, told me. 

Africa imports 99% of the vaccines it administers. “The gap is so big that our heads of state have stepped in and told us we must change the narrative,” said Ouma. “Our vision as Africa CDC is to see that vaccine manufacturing on the continent is 60% of what we need and [that we are only] importing 40% by 2030.”

Students attend an airing lesson in Kampala, Uganda, on Aug. 16, 2021. Uganda on Monday resumed airing lessons on radio for upper primary and secondary school levels as schools in the country remain closed. Nicholas Kajoba/Xinhua via Getty Images

Some countries, including South Africa, Senegal, Algeria, Egypt, and Rwanda, have started to build up their COVID-19 vaccine manufacturing capabilities.  

“Vaccine equity cannot be guaranteed by goodwill alone. Africa needs to and should be capable of producing its own vaccines and medical products. Rwanda commits to working with member states and partners to make vaccine equity a reality,” said President Paul Kagame of Rwanda during the joint high-level meeting on vaccine manufacturing organized by the Africa CDC on April 12. 

But before vaccine manufacturing takes off on the continent, many countries are still experiencing increased cases of COVID-19, especially with the emergence of new variants that are more transmissible and ensure every subsequent wave is more severe than the previous one. 

As time passes and the pandemic wears on, the public tends to become less vigilant about following social safety measures and exposure increases—vaccines remain the most vital and effective tool in the arsenal to fight the virus.

Museveni adapted the HIV leadership strategy to COVID-19

In 1986, under President Yoweri Museveni, Uganda adopted the first national AIDS control program, which featured a health education campaign to inform the public about how HIV was transmitted and how to avoid infection.

Together with local leaders at all levels, Museveni spoke openly about HIV prevention, stressing the “ABCs”—(1) Abstinence, (2) Be faithful, (3) use a Condom—and encouraging “zero grazing” (i.e., monogamy). These efforts resulted in reducing HIV prevalence from 18% to 6%.  

Now, with COVID-19, Museveni is once again speaking openly and publicly about prevention, using national addresses that are broadcast live on television and radio stations to enforce safety measures; this time, however, security forces are helping with the enforcement. 

The first national address occurred on March 22, 2020, and a lockdown was called into effect from March 18-30, including the closure of public places such as churches, schools, and bars. Museveni also imposed curfews, halted public transport, and stopped passenger flights by March 25 (most of the cases initially recorded were from travelers). At the time, Uganda had 126 confirmed cases and no deaths.

Thereafter, Museveni took to using national addresses to call for donations from the public—the private sector donated UGX 21 billion (about $6 million USD)—which garnered much-needed supplies in the form of cash, food, and even vehicles to be used in the fight to mitigate the spread of the virus. Museveni even used these occasions to demonstrate how much food families should eat and ration, and how to exercise in their homes to stay healthy.

Uganda made significant achievements during the first lockdown. The government distributed food to the vulnerable and even promised distribution of radios for learners who were locked out of school so they could study “on air.”

[A] lockdown was called into effect from March 18-30, including the closure of public places such as churches, schools, and bars. [President] Museveni also imposed curfews, halted public transport, and stopped passenger flights by March 25 (most of the cases initially recorded were from travelers). At the time, Uganda had 126 confirmed cases and no deaths.

Registered cases dropped, obviously, but there were unanticipated benefits, too—on the wildlife front, for instance, the number of animals increased in game parks as a result of fewer poachers. In Queen Elizabeth National Park, the Uganda Wildlife Authority (UWA) said they recorded more than 90 mammal and 600 bird species, and the population of elephants surpassed the 3,953 mark registered before the lockdown. Records also showed increased numbers of buffaloes and kobs.  

The public largely complied with the lockdown orders and stayed at home, which significantly reduced new COVID-19 cases, but there were other social catastrophes—within 14 days from the start of the national lockdown, Uganda police recorded 328 cases of domestic violence. 

Other social calamities have been exacerbated during the lockdown period. Child neglect, malnutrition, and strains on mental health increased. No schools for the nation’s 15 million school-going children means a lack of access to the internet, computers, and phones. And teenage pregnancies have gone through the roof.

In the year since lockdowns were first imposed, pregnancies among teenagers in Uganda have jumped from 24% to 35%, according to Reproductive Health Uganda. One district in northern Uganda, Gulu district, has reportedly registered 4,447 teenage pregnancies in a period of 18 months.  

In other districts, underage marriages and sexual abuse have been a persistent concern. In Lyantonde district, according to one report that has left many speechless, parents are allegedly colluding with sex offenders to marry off girls as young as 13 years old. 

Within just 35 days of the second lockdown, the sub-county of Amuru in Amuru district registered 170 cases of teenage pregnancies, according to a survey conducted by the African Medical and Research Foundation (AMREF) Uganda, a non-governmental organization working in partnership with Amuru sub-county through the Village Health Team (VHT).  

Albert Ladaa, the assistant community development Officer in Amuru sub-county, said the most affected were teen girls aged between 15 and 17 years. However, David Ocira, chairperson of Amuru sub-county, posited that the number of teenage pregnancies are higher than what was recorded in the AMREF survey because many more cases are neither reported nor documented.

There are also reports in regions like Karamoja that female genital mutilation is relatedly on the rise. 

Across the Sub-Saharan Africa region, UNICEF reported that over 32 million children are out of school as a result of pandemic closures due to second and third COVID-19 waves in some countries. That number, as the report states, “is in addition to an estimated 37 million children who were out of school before the pandemic.”

After the first lockdown

On May 4, 2020, Museveni extended the first nationwide lockdown while easing some restrictions. Some businesses, transport services, and essential health workers were allowed to move, but Ugandans were still required to wear masks, social distance, and abide by a nationwide curfew. At the time, Uganda had 89 confirmed COVID-19 cases, according to the Ministry of Health.

The public complied with these measures, even if the deaths from COVID-19 were minimal. After the second wave prompted a second lockdown, however, this one imposed for 42 days amid increased cases and deaths, the public was not taking it anymore. The only solution was (and is) mass vaccination. 

As of August 2021, a total of 904,601 Ugandans had received the first jab, representing 79.4% of the total received doses, while only 250,664 had been fully vaccinated, according to the Ministry of Health.

The Ministry of Health has reported high vaccine uptake and low hesitancy among the public. I myself had to go to the local health facility five times, waking up early in the morning, to get my second jab—most health facilities would say they were out of stock. Eventually, I was able to get the second dose of the vaccine at a different facility from where I got the first one, and after a long wait. 

Some officials attribute the high uptake to the second wave, which had a steady rise in cases, reaching a peak of 1,735 on June 10, 2021. As of June 30, 2021, cases started to decrease, but mortality still occurs. 

On Aug. 14, there were 137 registered new cases out of the 3,372 tests conducted, and 11 new deaths. Predictions are that if standard operating procedures are not followed, within 28 days there will be an average of around 500 cases per day, with a weekly average of around 2,000.

A COVID-19 patient is treated at the Namboole Stadium, a makeshift COVID-19 treatment center, on July 09, 2021 in Kampala, Uganda. In June, Uganda’s President Yoweri Museveni tightened restrictions in the country following a rise in COVID-19 infections and deaths. The new stringent measures included a 42-day lockdown and restrictions on the movement of people. Uganda has seen over 85,000 COVID-19 cases, and just over 2000 deaths. Luke Dray/Getty Images

The Ministry of Health is seeking 9 million doses of the Johnson & Johnson vaccines, which it hopes to procure through the pool-purchasing entity Africa Vaccine Acquisition Task Team (AVATT), before the third wave hits. 

As other countries push to “get back to normal,” Africa still has a long fight ahead. There is nothing luxurious about standing out of the queue. In fact, “people are yearning for vaccines. Africans have their arms stretched out waiting for vaccines—the situation has gone from people not interested to people protesting because there are no vaccines. There is no predictable supply of vaccines,” said Strive Masiyiwa, the African Union’s special envoy on COVID-19 and coordinator of AVATT. 

Masiyiwa observed that hesitancy has apparently dropped and more people now want vaccines, especially after Africans have seen the devastation COVID-19 has wrought in other countries, including the United States. 

“The third wave is raging in Africa and people are staying at home and not part of the crowds. While they remain locked up in their houses, they see what is happening in other countries. Ninety-nine percent of the people in US hospitals did not get a vaccine. They had a choice but they chose not to get them. They had a choice. They can get them anywhere, even on the subway,” he said.

Esther Nakkazi

Esther Nakkazi is a science and technology journalist based in Kampala and the founder of the Health Journalists Network in Uganda.