15 Mar Preventing Disease Outbreaks: Lessons From Uganda
Interview by Ashoka
Conservationist, veterinarian, epidemiologist, and health worker in the villages near wild habitat, Dr. Gladys Kalema-Zikusoka is an advocate for the well-being of both people and animals. She is teaching Ugandans how to achieve wildlife conservation through public health and prevent disease outbreaks. We asked Gladys for insights into the current novel coronavirus pandemic and how we can prevent future outbreaks.
The world is watching Covid-19 and learning a new word: zoonotic disease. What’s going on?
Some diseases cross species: animal to human, human to animal, or from one kind of animal to another, for example, from wildlife to cattle, which live in close contact with human beings. Ebola may have originally come from a still unknown source in the forest and hunters handling wild game spread it in their villages. We know that Marburg arose from fruit bat droppings here in Uganda. Both are deadly, with recovery rates as low as 10-20%. Scientists haven’t pinpointed the origin of Covid-19, but they suspect that it comes from eating wild animals. It has spread worldwide in weeks, probably because of air travel and a long incubation period. By contrast, Ebola victims get very sick very quickly. Ebola overwhelmed local health systems, but did not spread far or fast.
How does Uganda handle such disease outbreaks?
In much of Africa, the places where you find wildlife you also find very, very weak public health systems — or none at all. You might walk 20 miles to reach a clinic. There’s hardly any public transportation. People pursue the folk remedies they can afford. Such communities have close connections to the national parks and wild habitat for great apes. When we saw gorillas catching human diseases, we knew we had to deal with human and animal health together. We bring health services, we educate — basic stuff, like washing your hands. The government has now rolled it out elsewhere. We also encourage people to refer anyone suffering from strange illness to the nearest health center.
We have rules on hygiene. We must disinfect ourselves before, during and after we enter wild habitat. But even these guidelines are broken. Unfortunately, gorillas break the rules almost as much as people do. And it’s getting worse. We just published a paper on this (read here). The benefits of masks for general use are debatable, but masks help create awareness and help prevent spreading disease to others. Maintaining distance, washing hands, disinfecting and wearing masks in certain situations. In Uganda’s wildlife tourism, if visitors appreciate the need to protect themselves, we can make the link to animal conservation.
In Central Africa, primates sometimes enter the human diet. People can pick up diseases that the apes themselves contracted somewhere in the forest. As fellow primates, we are genetically similar, and that’s a risk to us both. Baboons, monkeys, gorillas, chimps — human health is a major factor in their conservation and survival.
How are early detection and warning systems in rural areas?
In this work, the first interface we manage is people and wildlife, and the second is people and government. We encourage people to report on local health conditions by SMS, make referrals, and seek treatment. A 2004 outbreak of anthrax in Uganda’s Queen Elizabeth Park killed 300 hippos and sickened 100 people who ate them. People trusted the community volunteer health workers and doctors enough to admit that they had eaten wild game. They told the doctor, “Look, I ate something strange and some people actually died.” They fear making such a confession to wildlife officials. We can treat anthrax with penicillin if we catch it in time, so the message needs to be that you will protect yourself and your family by seeking treatment quickly. In 2010, anthrax broke out again among the hippos. We joined the National Disease Task Force and educated people not to eat meat from unknown sources resulting in very few human cases and no deaths. Anthrax outbreaks tend to recur in ten-year cycles.
What do you predict we will see in the next five or ten years? What advice would you give the World Health Organization right now?
Zoonotic disease is becoming more common, and the impacts are huge. There is a strong argument to invest in prevention.
I see three trends. Global travel will make things worse, and more epidemics will become pandemics. Next, climate change: temperatures rise, pathogens multiply and mutate faster. Third is population growth. We cut down trees, put up buildings, and move into wild habitat.
Solutions require a multi sectoral approach. Doctors, conservationists, and teachers are learning to collaborate. Overall, we have to abandon the idea that wildlife health is a luxury separate from human health. We need more animal inspectors, and to monitor wild animals better. Markets in some Asian countries openly trade in wildlife. People don’t know what is safe to eat. The WHO really needs to play a role in helping people understand food safety.
How well is this going in Uganda? Which countries do this best?
We’re trying. Every national disease taskforce is now multidisciplinary. More and more countries including Uganda are developing national institutes of public health, like the Center for Disease Control. America is quite good in that area. But the fact is that nobody integrates everything well: wildlife, agriculture, human health, messaging. What’s needed is a new approach to public budgeting and allocation for preparedness and coordination. We must abandon the idea that healthy wildlife is something separate when in fact it is necessary to human health.
Dr. Gladys Kalema-Zikusoka has been tracking Uganda’s animals since she was a teenager running her school’s wildlife club in Kampala. Later, as a veterinarian she discovered that apes touched by tourism have more trouble with bacteria and parasites than those left alone. She works at the intersection of animal and human health in a setting where wild animals, cattle, and people mingle in unpredictable ways. She is the founder of Conservation Through Public Health www.ctph.org and an Ashoka Fellow elected in 2006. Read her profile at ashoka.org.