Epidemics that didn't happen
How Uganda improved its Ebola response in just three years
Three years after a devastating Ebola outbreak claimed 55 lives, Uganda contained an outbreak with four deaths using the 7-1-7 target.
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About Ebola
Rare but deadly, Ebola virus disease (EVD) is caused by a virus thought to have originated in fruit bats. In recent years, humans have also become virus reservoirs, spreading it through bodily fluids. Although there have been relatively few Ebola outbreaks since the virus was discovered in 1976, they have been devastating, with death rates ranging from 20% to 90%.
Initial symptoms are often flu-like but can progress to liver and kidney dysfunction and internal and external bleeding. Treatments, such as oral or intravenous fluids and monoclonal antibodies, can greatly improve survival chances. Effective vaccines against the Zaire strain of ebolavirus have been available since 2019 but are in limited supply. During recent outbreaks, the World Health Organization has coordinated swift vaccine delivery.
In 2014-2016 and 2018-2020, detection and response gaps resulted in significant delays that enabled two Ebola outbreaks in West Africa to spiral into larger, deadlier epidemics. These claimed nearly 14,000 lives.
What Happened
On January 19, 2025, a thirty-two-year-old male nurse became ill—complaining of headache, body pain, high fever, weakness and trouble breathing—while working at Mulago National Referral Hospital in Kampala, Uganda. He was treated for malaria, which is endemic in the region; misdiagnosis is common in Ebola’s initial “dry” phase, when symptoms resemble those of diseases like typhoid, meningococcemia and malaria.
After several days, the nurse’s symptoms worsened. He sought care at several health facilities in the area, including a private clinic and a traditional healer, before being referred back to Mulago National Referral Hospital, where he died in the intensive care unit on January 29. A post-mortem blood sample tested positive for Sudan ebolavirus, which causes a particularly deadly form of Ebola.
The Response
Timeline
Target: 7 days
Emergence
Detection
Target: 1 day
Notification
Target: 7 days
Response
Even though the nurse’s symptoms were initially misdiagnosed, laboratories moved swiftly to sound the alarm just six hours after receiving the blood sample on January 29 and kickstarted a massive response effort across the country. “Once the labs confirmed a positive case, there was no hesitation—we took immediate action and declared the outbreak on January 30,” said Dr. Allan Muruta, Commissioner of Integrated Epidemiology Surveillance and Public Health Emergencies at Uganda’s Ministry of Health.
With funding from Resolve to Save Lives, Uganda’s Infectious Diseases Institute partnered with the Ministry of Health and the World Health Organization to establish treatment and isolation centers and stop cases from spreading. These funds also enabled authorities to quickly deploy national and district task forces and rapid investigation and response teams that included clinicians, epidemiologists and infection prevention and control experts.
Uganda’s national public health emergency operations center worked with its 12 regional counterparts to coordinate widespread contact tracing, testing and isolation efforts. Contract tracing began within 24 hours of the outbreak being declared, starting with the nurse’s relatives. Through this process, the team successfully located some of the nurse’s coworkers and people he encountered while traveling and seeking care, but convincing contacts to enter isolation for 21 days was a challenge.
We had to convey urgency, stay calm and acknowledge that people might panic or be reluctant to isolate. That meant stressing vigilance and addressing community concerns.
Dr. Charles Olaro, Director General Health Services at Uganda’s Ministry of Health
“We had to convey urgency, stay calm and acknowledge that people might panic or be reluctant to isolate. That meant stressing vigilance and addressing community concerns,” said Dr. Charles Olaro, Director General Health Services at Uganda’s Ministry of Health.
Social workers, religious leaders and community health workers all played pivotal roles in effectively engaging communities. They shared accurate health information that dispelled rumors about the disease and provided counseling to encourage positive behavioral changes and address some of the stigma surrounding Ebola. They also played a critical role in encouraging contacts to enter quarantine facilities, stressing that separation was essential to protecting loved ones.
National authorities already had several communications products created during a previous outbreak, which they quickly modified to create a range of fresh web, social media and radio content. The response teams, meanwhile, distributed brochures and flyers to local health facilities and communities, informing them about how to best protect themselves and what to do if they developed symptoms.
In total, 534 contacts were identified across six major cities. Ten people were diagnosed with Sudan Virus Disease while alive and they all survived, an outcome attributed to rapid detection and timely care. Two additional infections were identified through post-mortem testing and two deaths are suspected to be related based on epidemiologic evidence. The outbreak was declared over on April 26.
Enablers
7-1-7 for performance improvement
Rapid laboratory testing
Availability of fast, flexible funds
Engaging local community leaders
Learning from past experiences
Uganda experienced seven Ebola outbreaks between 2000 and 2022 and became the first African country to adopt the 7-1-7 target in 2021. When an outbreak occurred in August 2022, it took authorities 46 days to detect the outbreak and nine days to mount an initial response, which did not meet the 7-1-7 target and allowed the virus to spread rapidly. The result was a large outbreak that resulted in 142 confirmed cases and 55 deaths.
In the aftermath of the outbreak, health authorities sought to identify the challenges that hindered detection and response efforts. Having integrated the 7-1-7 target into its national and subnational operations in partnership with Resolve to Save Lives, the Ministry of Health identified major bottlenecks in the 2022 response. The team’s review confirmed inconsistencies in how health care workers were being trained and delays in laboratory testing of cases and deployment of vaccines to health care workers.
By the time the outbreak arrived in 2025, officials had spent the intervening three years addressing these issues, including large-scale training programs of community health workers and surveillance officers and critical upgrades to sample transportation and testing facilities. The response to the 2025 outbreak marked a significant reduction in cases and deaths when compared with previous outbreaks, which authorities attribute to the use of 7-1-7 for performance improvement.
“For Uganda, 7-1-7 is a promise to our communities,” said Dr. Olaro. “No outbreak should circulate unnoticed, unnotified or uncontrolled when the systems exist to act faster.”
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