We need it now: Uganda and the critical call for COVID-19 vaccines

Mercy Corps team member, James Longok, speaks with people in Karamoja during a peace-building session.
Mercy Corps team member, James Longok, speaks with people in Karamoja during a peace-building session.

In a country of about 48 million people, it is estimated that roughly 2% of Ugandans have received their first or second dose of the COVID‑19 vaccine. As of early August, a little more than 1.2 million doses of the vaccine had been administered in Uganda. We have no way to know how far the virus has spread in Uganda because of the low testing capacity in the country. The health systems are overwhelmed, and sooner or later, there will be no space or adequate healthcare staff to admit severely ill patients who need critical care.

Even as we emerge from a strict lockdown meant to control the spread of COVID‑19, we see many families struggling to rebuild after their livelihoods were limited due to the lockdowns. While Mercy Corps’ programmes here in Uganda offer grants to small businesses and cash assistance to families in order to meet their urgent needs, we must also have vaccines in order to protect our communities.

A person sitting alone.
Mercy Corps supports village health team members, like Ayenget Florence, trained to identify and treat malnutrition, as well as other common diseases, right in her own community in Karamoja. The COVID-19 pandemic has exacerbated hunger across Uganda and village health team members help support families facing malnutrition.

The pandemic has exacerbated existing challenges across Uganda and threatens to reverse hard-won progress while risking more people slipping deeper into poverty, further worsening social inequities, divisions, and conflict. In July, I spoke with Jared Rizzi on the “At The Table” podcast about how the pandemic had deeply affected our communities and how Mercy Corps’ programmes provide support during this time.
 
Jared Rizzi is a former White House correspondent who hosts thoughtful conversations about politics and community. I appreciated the opportunity to speak with him, openly and frankly, about the dire situation in Uganda. We talked about how people are desperate to earn a living, supporting refugees and internally displaced communities, and the resilience of Ugandans in the face of difficulties brought on by the pandemic.

Listen to the full episode of “At The Table” here.

Transcript of “At The Table” with Jared Rizzi and Edward Simiyu:

Jared Rizzi: For those of you who listen to At the Table, again I'm Jared Rizzi, the host and I've been thinking about all of us emerging. We've had the cicadas that are now completely gone on the eastern U.S. on this point. They've gone. But it felt like so many of us were emerging along with them from COVID. It's really a luxury. You have this situation where these bugs that have been underground for 17 years come out. They're out for a couple weeks and they mate, and then they die. And honestly, sometimes that's an admirable situation. It feels a little bit like, for many of us, in the United States right now, the chance to emerge is upon us. The chance to get out and experience a little bit of life. Because of the high percentages of vaccination. Because of the ability, the privilege really, to have this kind of availability. To say no, and so many people have. I mean, you see more of a discussion in the United States about people willing to say no. That is an enormous mountain of privilege that they are sitting on top of. And I think it's important to recognise that.

We have a child that's under the age of two, who probably won't be able to get vaccinated for some time. And all these worries are percolating, like really bitter coffee, in my brain as I'm sitting here and stewing on these feelings. And I was gratified because a friend of mine connected me. For this conversation, I'm so glad to be able to share it with you, because it's a reminder that we've been, like those bugs underground for 17 years, we've been completely in our own world. Isolated and thinking about what's affecting us for so long, even for just a year, a year and a half, whatever it's been it feels like much longer, but it's really been a short amount of time. And it's important to make sure that we actually emerge and look around before we make these decisions. And I'm gratified and humbled to be joined by Mercy Corps' Uganda Country Director, Edward Simiyu, who is with me now. Edward, thank you for joining me at the table. And thank you for spending some time.

Edward Simiyu: Thank you, Jared. It's a great pleasure to be here and to be able to have this conversation with you this afternoon.

Jared: For those of us who are in our own little dirty tunnels, as I'm thinking about these bugs underground, you're experiencing in Uganda, a much different COVID time than we have in the east coast United States right now. Can you give me a sense of what the situation is like on the ground? What you've been experiencing? If you can, also, the mission that Mercy Corps has to ameliorate any of the circumstances the people are experiencing.

Edward: Thank you, Jared. As I speak right now, Uganda is going through a very harsh second wave of the COVID spread. The first wave came in last year in March, and Uganda did institute quite some very heavy, stringent measures to control the spread. In a way, that was successful. The measure was a very strict lockdown where no one was allowed to leave their house, no vehicle movement. You only had to move around with a movement permit. So, households, families, individuals were all locked down. And in a sense, it was able to contain the spread. For quite some time, we had some of the lowest figures in terms of COVID infections for a good part of last year, including up to March of this year. There were actually days where we registered zero COVID infections earlier this year, February and March.

But suddenly the numbers started getting concerning in April and May. And then immediately in June, numbers shot up so rapidly to about a week ago when we had the highest, about 1,754 cases registered in one day. These numbers are actually understated because the country struggles to get its data in place. There is no adequate manpower to record. There are no adequate testing facilities. And largely, these are mainly in urban areas where people have access to medical services. It doesn't cover much of the rural population. Which, as you know, is made up of about 80% [of Ugandans]. The 1,754 number was, while it was an official figure, the government acknowledges it was understated. But what was quite concerning was the high level of infections. The variants that were going around were very, very infectious. And this time around, unlike in the first wave when the people affected were mostly the elderly and those with pre-existing conditions, these were attacking young people, school-going kids, people under the age of 30 were so badly affected.

Within a week or so, we had all of the hospitals totally outstretched. There were no beds in hospitals. Hospitals were running out of oxygen. It was really serious.

I remember going to hospital myself with a toe injury. It took me four hours to be attended to. Finally, when I was done and I was given paracetamol just to manage the pain and fever that I had, I swore never to go back because I said I can't stay for four hours just to be given paracetamol. But it was because of the numbers that the hospital was struggling with to cope. It's been very, very serious.

But this time now it actually struck close to home. I chair a network of country directors in Uganda. We have 150 international non-governmental organisations in Uganda. For the first time, I heard of country directors contracting COVID, we had more than 10 in our network having contracted COVID. We lost two country directors in the last week. So this is how it has been. At Mercy Corps, we had nine cases of infection. Thankfully, all of them are recovered, except one who is still in hospital now and he was at one time on a ventilator but right now he's moved on. He's improved and he's on oxygen as we speak. This is how close it has been. With other agencies, there is an agency that has lost four staff from COVID. And several others. It's been so ruthless that this time around it wasn't as selective as it was in the first wave. It's been eating at everyone. Those in high places and those in low places. It's been very concerning. So that's where we are. And now we are, because of the way this was spreading, the government instituted some more measures of stricter lockdown. So as I speak now we haven't been out of our homes for the last over two weeks. And that's how it's been.

Jared: A lot of the folks who listen to this conversation are coming from a U.S.-centric perspective. And I'm sure, as your work in international development and aid, you know that the United States perspective is sometimes a very strong set of horse blinders that prevents us from viewing other parts of the world with clarity and compassion at times.

Edward: That's true.

Jared: I'm glad that you can at least agree because sometimes I'm trying to offer it as kind of a mea culpa and people don't even take it and then I feel even worse. Because then I know they know.

Edward: [laughs] You know, Jared, I was in Kansas years back. I was in Kansas and I was giving a talk on some of the programmes I was working on. I think this was probably 2009 or 2010. I was trying to describe how some households in western Kenya, some of the remote, very dry, arid areas struggle. They have no water. The rivers dry out during drought and they have to dig six feet on the riverbed to literally get some dirty water that they can live on. And after I gave my speech and talk, a gentleman came to me and told me, “I don't believe what you say. Because I don't think people can be that poor.” And I looked at him and I saw this gentleman is like my age. We are now in our fifties. And I looked at him and I couldn't find words to respond to what he had said. So I told him if all you know and all throughout your life you have been in the U.S. then you've not known the world. The world outside the U.S. actually is so different. What you have is a privileged life and you should be thankful for what you have. The rest of us out there, it will be unsurprising to go without food, to go without water, or literally to fight for our lives because what would be free, available, or easy access in the U.S. is not so in the rest of the world.

Jared: Edward, I'm not sure what you're talking about because we were fighting each other for toilet paper last year.

Edward: [laughs]

Jared: And that was... I mean, these were warlords going to grocery stores and buying. [laughs] Let me back up. I don't want to take away from the seriousness of what we're talking about. Even though I think we both know that these truths... if you're not laughing, sometimes you're crying. I think you and I both seem to be the kinds of men who would rather laugh sometimes.

You talk about these lockdowns. And again, the folks who listen to this conversation, because of my background in politics, we've been very clued into the arguments that are happening in this country—to this day—about whether we should be locking down, or whether we should be masking. My wife and I have another friend who lives in the Philippines. And obviously with the Duterte government there's a whole wasp nest of other problems there, but she was talking about the same kinds of lockdowns that you're describing. And it's unimaginable to me, when we're having these conversations and talking about the ways in which people are limited. You talk about the benefit of this but the lockdown that you're describing is nowhere near the laissez faire attitude that was happening in the United States in April and May and June, and even up till now. You're talking about actually not being able to leave your homes. I guess my question for you is why is it happening now that the attitudes are different? Is it just fatigue over the restrictions or is there something else in play? Is the government not able to make these rules and keep them as they were a year ago? What's happening that's different now? Or is the Delta variant situation just an x-factor that's not containable at this point?

Edward: Earlier this week, I cried when I heard of some households and families that are really struggling. And indeed, we are struggling. There was a man who decided he's just going to go out of his home and go to the streets and try and sell something in downtown Kampala. And the police are going around trying to beat people out of the streets and they found this man and he's handicapped. The police wanted to beat him up but they looked at him and they saw his condition. So they didn't beat him up. But they asked him, “Why are you out here?” He said, “Look, I'm out here because I can't stay at home. How am I going to feed my wife who has just newly given birth? I have a baby who is just days-old and I have another one and I need to feed them. If I can't get out and if I can't try and sell something and go back home, what am I going to tell my family? We cannot all sit there and die? At least let me come out here. That's why I came out here.” And they told him, “But who are you going to be selling it to?”

Jared: I was just thinking about that. This is a terrible business model. [laughs]

Edward: Exactly. And he said, “Look, at least my family knows that I'm out here trying to do something.”

Jared: Yeah.

Edward: “It's not so much of how... If I sit at home, it's like I'm doing nothing. I need to do something. I don't know what it is, but for me this is what I had to do. I had to come out with these wares of mine and try and sell and see if I can go home with something.” And they let him know, “You have to go home.” And he said, “No, no, no. You'd rather kill me here. Even if you are to beat me. Beat me and kill me. Let my family know that I died trying. As opposed to going home and they feel like I haven't done anything.”

This is what these lockdowns are pushing people to. People are struggling. We work with a community of refugees here in Uganda that we support in the urban areas as well as in the refugee camps in West Nile. And the other day, yesterday, I received an email from them telling us, “Please, can you support us to get masks, to get gloves.” Because right now it's actually an association of refugee drivers. So they said, “We are now having to step in and attend to refugees who are ill. We have to take them to hospitals using the vehicles that we have. But we don't even have the money to fuel the vehicles. We don't even have money to buy gloves, masks. And some of them, when we take them to hospital, they even die on the way. And now we have to take the responsibility to bury them. We don't have any resources at our disposal. Could you please help us?”

And look, I have no money within our programming that we have designated for such needs. So I look at that and I'm almost tearing myself up. How do I help with such needs? Great, great needs that none of us would have imagined have come out that we can't ignore. We can't let people struggle while we are able to intervene. So these are some of the challenges and realities that are facing so many families. There are those that are going without food. There are those that are literally, they are like, “Maybe I should just go out there. If I die, let me die.” These are perceptions that they'd rather [do] than stay in their house and die anyway. So this is what we are facing as we speak and this is what the lockdowns are pushing people to.

Jared: There is a universal agony that we are facing and whether you're in Kansas or Washington, D.C. or Kampala, wherever we are, humans are not meant to live in this way. Where we are isolated, whether it's the real isolation of actually being rounded up by police if you leave your home or the kind of white-glove lockdown that the United States has experienced. But I think all of us have had that taken away from us where we know that feeling of this isn't how human beings are meant to live.

Edward: Exactly.

Jared: But there's another factor here. And this is something that, again, it was brought to my attention by the work that Mercy Corps is doing, and we're talking about very different vaccine penetration numbers here. Here in the United States, we're just about to hit the July 4th Independence Day holiday. The Biden administration has set this ambitious goal which looks like we'll almost hit it of 70% penetration of people who are vaccinated. Uganda's talking about a much lower number, I think 2% is what I saw. And that's a different universe of responsibilities, possibilities, live-living. This is dangerous in two ways that I can see. One, obviously, for the people who are experiencing it, not vaccinated, and not being able to feel this enormous relief that I've felt. I mean, I was able to get the vaccine a few months ago and I felt... I cried in the room when I got it. And I cannot imagine people waiting longer. I wanted to give it to everyone I could because I wanted everyone to feel that relief. But there's also the other side of this, which is that when the vaccine is left unchecked in any population, we have the potential for the mutations and that of course leads to the Delta variant that we've seen affecting a lot of places, including in the United States, but of course also where you are. And from either the compassionate or utilitarian argument, there's a real need to fix this problem. Can you talk about the difference between 2% and 70%, and what you're experiencing and what that's done? Because I cannot even imagine, I can't feel that, but I want to try to help me understand.

Edward: Just on that is very, very concerning. Uganda received 960,000 vaccines earlier in the year. That was, I think, in April. Less than one million in a country that has a population of 48 million people. We have less than a million vaccines. These vaccines ran out and they ran out at a time when the second wave was beginning. So right now, as we speak, the only batch of vaccine that came in was last weekend. And that 176,000 vaccines. So you are looking at, even the people who had the first round of 960,000, the ones that have come in cannot even cover that population. They cannot even get the second round jab, and cover all the ones who are vaccinated in the first round. That's how serious it is.

But from even a more concerning perspective, you see the reason why the United States is aiming to have 75% of the population vaccinated. It is that to be able to control and contain this and reduce the spread, you need to have a larger part of the population immunised so that they're resistant to the virus, and to prevent the virus from spreading. That way you protect the smaller population of people who are not vaccinated. Because there won't be as many people who have it around.

Now, in Uganda, what is even more worrying now is that we are seeing infections catching up with people who have been vaccinated, including people who have even had their second round of vaccination. And we have had some of them die. Why? Because if you're just going to vaccinate a million people out of 48 million people, eventually you have so many people infected around them that whatever vaccination they have, doesn't even have an effect. And that's very, very concerning. Two of our country directors who passed away, one of them was fully vaccinated. So that's worrying now.

What is even more concerning now is that we all know that the thing that can get us out of this is a vaccine. But when we go out there, there are no vaccines. Right now, people are queuing and, when they hear that these 176,000 vaccines came around, you'll find the lines are full of people who are going for the first round, yet the government made it very clear that the vaccines available are for the people who are going in for their second shot. People are desperate. But there is no help for those who need it. So that's what is worrying. That's what is frustrating. And we hope that this can be addressed very soon.

Vaccine equity is a critical need. And look, what options do people have? A lot of people don't have medical coverage here. No insurance coverage. So when you fall sick right now, you're going to be shipped into a hospital. The bill is going to be over $1,000. This is way beyond what many households can afford. Hospitals are demanding a down payment of not less than $1,000. Very few people can afford this. So what we are having is a situation where people are actually dying when we could have saved lives.

It's an extreme situation. It's an apocalypse that we are facing. We just need to make sure that people get vaccinated as much as we can so that we can have the virus contained and controlled. Otherwise, locking down people is not sustainable. It's not going to be sustainable at all. We need the vaccine. We need it out. We need it now.

Jared: Again, I'm thinking about the contrast. I have a family member who said to me that the reason they're not getting the shot is, “It's not that bad here.” I remember those words. I can still hear them in my ear and think this is so foolish and so privileged to say, “Well, in my little corner of the universe, it's fine. And I'm not going to pay attention.” What's laid bare in the experience that you're describing is that nobody can say that because it's everywhere. And there's no one who can say that they're not touched by this. And I hate to look upon this misery and say for the folks who are even just concerned about a U.S. audience, this is a caution to be seen. If we are cavalier about the spread, even with these new variants. Because, for people who are listening, if you're in an area of the country where the vaccine population is lower, 20%, 30%, some of these places are like that, you're running the risk of exactly what you're describing, Edward.

But then, of course, there's the larger problem of you're not just describing a cautionary tale for our experience, you're describing human misery on a scale that I cannot even comprehend. I want people to know that the work you're doing at Mercy Corps is something that they can support. Can you explain a little about what the mission is right now? Because, obviously, as a country director you deal with any number of issues. You talk about food insecurity, you're talking violence insecurity, you're talking about medical insecurity. I'm guessing this has been the main thing on your plate for some time. How can people support the mission and what is the mission right now, from your perspective?

Edward: Right now, Jared, we have interventions across the country. We have nine offices in Uganda. We serve some of the most underprivileged populations in this country. We have six field offices in a region called Karamoja. Karamoja receives very little rainfall, so most of the area suffers from drought. The population is largely pastoralists community, who move from place to place. Partly, they have to do that because they have to look for grazing when the drought strikes. Also water is very scarce. These are the people we reach out to. And because they are moving from place to place, our interventions are to help them settle and try to cope with the challenges of climate change. But also build resilience in terms of their food security, and be able to cope with the challenges created by those demands around them.

As you probably know, this pressure also creates conflict. Because when they move around grazing, they are definitely trespassing on other people's land. And sometimes they even cross territories. That whole region is a belt that goes all the way to Kenya and South Sudan. It's a whole dry region that is also a hotbed of conflict. And on the side of Uganda, even when the government forces go in there and try and contain the situation, sometimes it gets very violent. So, again, we have to work on peace mediation. Try to pacify communities to be able to coexist with each other, and share their limited and few resources that are around, in terms of natural resources such as grazing and pasture.

But then we also try to make interventions in helping them to grow crops. So that they are not only dependent on livestock but they can also grow crops where possible and where water resources are available to do some small irrigation projects.

We are working with young people in those areas as well. To be able to build their skills so that they can also be able to acquire some assets. These communities believe that their wealth is in livestock, so owning a cow is a very privileged status. The more cows you have, the more wealthier you are. Assets are valued in terms of cows. We have a lot of veterinary activities going on, livestock improvement programmes, just to make sure that we are addressing the needs where they are. We also do a lot of work on the western side of Uganda. This is West Nile.

You may know that Uganda presently is hosting a population of 1.4 million refugees. These are people who are displaced from South Sudan mainly. We also have refugees from Congo, and others from Burundi, Rwanda, and other countries around. The refugee population are such a very, very needy population. They came in empty-handed and so we make interventions of helping them to get shelter, the basics of water, sanitation. In our case, we are working hard on equipping them with skills, giving them seeds so they can grow and harvest a crop that they can support themselves. Small subsistence farming, mainly to provide for their household food. In some cases, we are also helping them graduate to be able to produce for the market. We have various interventions that are targeting towards that.

For those who go to our website, you'll learn that Mercy Corps does a lot of market systems approach where we empower communities with tools and skills that can actually help them play a role in the market. We strongly believe that if we can bring the poor, if we can bring the marginalised to participate in the market, to be able to create something, produce something, and be able to sell in the market—that can eventually sustainably get them out of poverty. We believe in empowering the communities as opposed to giving them food, we give them the seeds and the resources that they would need so that they can actually generate and produce the food to sell, feed, and be able to acquire some resources out of that. These are some of the interventions that we have.

Within Kampala, we also support refugees in the urban context. We have set up various platforms. There is a website that we created recently where refugees can actually get onboard and offer their skills or some of their wares that they want to sell, and be able to earn an income and support their livelihoods. We also give microgrants to those refugees who have businesses in Kampala, to be able to restock. Right now, the challenge is actually stocks, because many of them, as a result of COVID and businesses not operating, or rather people not being able to buy, a lot of them are not able to sell much. So they need some bit of capital. They need some bit of relief, support to keep them going for the lockdown period, which was indicated as 42 days.

You can imagine, I was so pleased yesterday when I received some news from one of our colleagues in Portland who told me that we have some $45,000 that we can do cash transfers to some households. So we will be distributing about $140 to each household. We believe, with these households there are about five people, that this money, as little as it is in other quarters, it will be able to take them through the 45 days of lockdown.

These are some of the needs we are trying to deal with and cope with. But, as you know, the resources are short. We would do with a lot more and be able to support more households.

Jared: And all I can think of when you're describing refugee communities or internally displaced communities, these are places that are usually tight quartered. These problems are compounding each other. Again, that level of support is low but I know that some of the folks who are able to listen here would be able to help, so I would encourage them to do so. I'll make sure to include some links in the description of this episode because, again, people who are interested in this work. I think about how my wife used to work for Grameen Foundation, which does exactly some of the work that you're describing with microloans and a few other things. I know that work and obviously Mercy Corps doing a lot of work. My wife had the benefit of going to Uganda and I am just so sad that I was not able to get there before all of this. I'm very hopeful that we will be able to make that trip when all of this is over—a phrase that carries a lot of weight at this point. In a world where, Edward, we've had so much taken from us in the last year and a half. I am very grateful that you are continuing the fight to make sure that we have a few things that will come out of this. I'm very grateful for your time today.

Edward: Thank you, Jared. We'll be happy to host you. We'll be happy to have you visit the field and meet the communities that we work with. It would be a great pleasure to have you. It's been a joy to be with you on this roundtable.

Jared: The pleasure is really all mine. I really hope that you continue to be as healthy as possible. I know when the virus affects people that are close to you, you cannot help but have that flash moment of, “This can also happen to me.”

Edward: Exactly.

Jared: And I think that everyone listening to this conversation knows exactly that feeling. Maybe not as intimately as you do, but, again, appreciate both the expertise and the intimacy that you've offered today.

This is Mercy Corps' director for Uganda, country director for Uganda, Edward Simiyu. Edward, again, thank you for joining me at the table. I will make sure to include some descriptions that will help people direct to the mission that you are doing there. Thanks again, Good luck, stay healthy, stay safe.

Edward: Thank you. Thank you, Jared.

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