If Covid had hit Uganda in its golden 1990s vaccine age…

By Monday, only 1,015 people in Uganda had been vaccinated against Covid-19, far short of the government’s own target of 150,000.

This is more than a week since the country received 964,000 donated doses of the AstraZeneca Covid-19 vaccines. According to a report in Daily Monitor, the Ministry of Health said the low number was due to delays in delivering the vaccines and other essential materials to most districts. Additionally, that some vaccination data was yet to come in.

Vaccination distribution generally is a logistic nightmare, even in rich industrialised nations.  A few countries like South Africa, and in the region Rwanda, which is closing in on 300,000 vaccinations, hit the ground running, but Uganda is likely to struggle. Why is this the case? In her book Another Fine Mess: 

America, Uganda and the War on Terror, the dogged American professor of human rights and public health, Helen C. Epstein, who annoyed our Big People over the years with her writing, argues that it is down to repression and corruption. 

In a bare-knuckled opinion piece in the Los Angeles Times on October 15, 2017, she wrote: “I teach and write about public health in Africa. For years, something about Uganda stumped me.

“Since 2000, health services have improved in most African countries, but Uganda’s progress lags. Yet Uganda has a remarkable medical history. Well before colonial times, the Baganda, Uganda’s largest tribe, could distinguish plague from smallpox; Baganda traditional surgeons performed caesarean sections in the 19th Century, when Europeans considered them too difficult and dangerous. During the 1950s and 1960s, Ugandans helped pioneer treatment for childhood cancers and malnutrition. When Singapore was looking to reform its health system in the 1960s, it sent a delegation to Uganda.

“Today, Uganda’s health system is a shamble, even though American taxpayers plow hundreds of millions of dollars annually into medical projects there. Bats, snakes and other wildlife have taken up residence in once-functioning rural clinics. Uganda’s children die at twice the rate of those in neighbouring Rwanda and Kenya, and those who survive are among the least likely in the world to complete elementary school. 

“The main referral hospital is so dysfunctional that women giving birth there are seven times more likely to die than when Idi Amin was Uganda’s president in the 1970s. Meanwhile, Uganda’s government spends $150 million a year flying the president and other elites out of the country when they need medical treatment.

“It’s become clear to me that corruption, combined with the government’s callous indifference to the plight of ordinary people, explains these problems.” 
 
It’s a long piece, but the conclusion one draws is that corruption diverts resources and medicines to private gain, and the people in charge will kill the systems that distribute things like vaccines because it is competition. 

And, secondly, if you are busy clobbering and torturing your people, you don’t have the empathy necessary to invest in getting vaccines to them. But this is only part of the story. Something unique happened when Uganda announced its Covid-19 vaccine. It said private health establishments would also be able to give vaccines, ie at a commercial rate. 

So far, no African country has been so publicly specific about such a role in the Covid-19 for for-profit health entities. However, it was an important signal that it knows previous vaccine successes in Uganda, that President Yoweri Museveni likes to boast about, were not a wholly government affair. They wouldn’t have happened if that were the case.

From about 1988, but particularly between 1994 and 1998, there was an impressive vaccination wave in Uganda. The star of the show, without doubt, was the United Nation’s United Nations International Children’s Emergency Fund (UNICEF). 

In the lead-up to, and after the end of the Cold War, the UN, and indeed other institutions like the World Bank, went through a period when they appointed a wave of cheerful enlightened leaders. Uganda had quite a few of them then, and they brought their outlook to bear on vaccinations.

There was also a dramatic rebirth of Rotary Clubs, a result of a mix of optimism from an economic boom, euphoria about the building a “new Uganda” as the making of the 1995 Constitution got away, and also a safe haven for public engagement in a one-party era. The Rotary Club, and other NGOs, just drowned this country in vaccination drives.

This massive participation was made possible because it was also the internationalist and quasi-enlightened phase of the Museveni government that made space for them; credit has to be given. 

However today, the Uganda State is more ham-fisted than ever, is very hostile to civil society, and is unusually municipal in its mindset.  Recreating the near-miracle of the 1990s and early 2000’s vaccination, is a tall order.

Mr Onyango-Obbo is a journalist, 
writer and curator of the “Wall of Great Africans”. [email protected]