How did Uganda respond to the COVID-19 pandemic?

Public health and social measures (PHSMs, also known as nonpharmaceutical interventions) like social distancing and mobility restrictions were a critical part of Uganda’s early response to COVID-19. Officials acted swiftly to implement them in March and April 2020.²⁰  

On March 18, 2020, even before Uganda reported its first COVID-19 case, President Yoweri Museveni closed the country’s airports and territorial borders, quarantined travelers when they arrived in the country, and suspended all mass gatherings—including worship services, concerts, rallies, and cultural gatherings. Shortly thereafter, officials suspended public transportation, restricted the use of private vehicles, and declared a nationwide curfew, prohibiting all movement between 7 p.m. and 6:30 a.m.^21,22 The government also closed public places such as bars and restaurants. On April 1, 2020, a nationwide lockdown banned all forms of public and private transportation and closed all businesses except for essential supermarkets and pharmacies.²³

Starting in March 2020, all educational institutions in Uganda closed. They remained closed for nearly two years—the longest pandemic school closures in the world.²⁴

Authorities began to lift Uganda’s first national lockdown on May 21, 2020.²⁵ In June 2021, as case counts surged, President Museveni introduced another partial lockdown. Some travel was banned, open markets were closed, and church services were suspended. Schools remained closed all along.^26,27

By December 2021, Uganda had implemented nearly a dozen different PHSMs including suspending international flights and establishing isolation centers, land-border restrictions, curfews, mandatory quarantine for travelers, mask mandates, and more (see figure below).²⁰

The PHSMs that Ugandan authorities implemented to control the spread of the COVID-19 pandemic in 2020 coincided with a sharp drop in mobility during the pandemic’s early months (see figure below). This likely limited COVID-19 transmission, but researchers believe it also limited commercial activity, decreasing incomes and reducing economic growth, and introduced supply- and demand-side barriers to EHS delivery.

On May 4, 2020, Uganda’s president required all Ugandans six years and older to wear face masks in public.^52,53 Those not wearing masks were barred from entering public places, and the police were empowered to enforce this policy.⁵⁴

Even with the enforcement efforts of police and security forces, researchers found that mask use was inconsistent (see figure below). The reasons behind low or inconsistent adherence to mask use varied over time and space, and may have included perceived threat of disease, availability, or social norms. According to a 2021 survey of people in the Greater Kampala Metropolitan Area, a majority sometimes or always wore a face mask inside and outside public spaces, but the authors concluded that officials still needed to “raise awareness about face mask wearing and its efficacy to prevent COVID-19 infection.”⁵⁵

In Uganda, partnerships with nongovernmental organizations (NGOs), private companies, and foreign governments enabled health workers, facilities, and village health teams (VHTs) to obtain essential PPE. Enforcement of PHSMs also provided opportunities for increased domestic production of masks and other key protective and pharmaceutical goods.⁵⁶

For instance, by April 2020 the Uganda National Bureau of Standards had certified 38 local companies—many of which had previously manufactured alcohol or other goods—to manufacture hand sanitizer.^50,57 By January 2020, the bureau had certified nearly 140 companies manufacturing 182 brands of sanitizer. Some of these supplies were exported to neighboring countries.⁵⁸

Indoor and outdoor mask mandates inspired high demand for disposable medical masks as well as cloth masks.⁴⁹ To meet this demand, Ugandan textile producers such as Nyanza Textile Industries Limited and the National Enterprises Corporation (the industrial arm of the Ugandan army) began to produce them at scale.59Even at the local level, small-scale entrepreneurs produced and sold protective goods such as cloth masks.^60,61 Entrepreneurs and donors also produced handwashing facilities for the public to use: for instance, teams of young people worked with an NGO in Kamwokya, Kampala, to build free “hands-off” handwashing facilities for local businesses.^62,63

In Uganda, the COVID-19 pandemic and especially the enforcement of PHSMs such as movement restrictions during its early months had profound negative economic effects:

• Economic growth slowed.
• Movement restrictions led to business closures, increasing unemployment, and reducing household incomes.
• Gender-based poverty increased.
• Reduced household incomes led to food insecurity.

Surveys showed that these consequences disproportionately affected women, young people, refugees, and informal workers such as agricultural workers and small vendors.^67,68,69

In March and April 2020, Uganda implemented interventions designed to mitigate these economic challenges.

Food distribution

To address food shortages caused by COVID-19 lockdowns and other measures, at the end of March 2020 Ugandan officials implemented a program for food distribution, funded by a supplementary budget and donations from partners in the private sector. Most of its beneficiaries were low-income urban households, the elderly and infirm, and nursing mothers. The program also gave priority to people in Kampala and the neighboring Wakiso district.

Each ration included salt, 6 kilograms of maize flour, and 3 kilograms of beans per person. Nursing mothers and the ill also received 2 kilograms of powdered milk and 2 kilograms of sugar.^70,71

Reports indicate that there were flaws in this program: food was distributed slowly, its quality was sometimes poor, and many of Uganda’s most vulnerable households—including rural dwellers and refugees—did not receive any rations.^64,72 In general, food distribution programs targeted the urban poor in Kampala, Wakiso, and Mukono. A countrywide survey conducted between May and June 2020 noted that only 13% of people received some food assistance: 24% of city dwellers reported getting food assistance, but only 7% of rural dwellers did.^73,74

Receipt of government assistance according to survey conducted by the Partnership for Evidence-Based Response to COVID-19 (PERC) in September 2021

Social safety nets

Though COVID-19 led to the escalation of sexual and gender-based violence (SGBV) against children and women, few measures were in place to alleviate it. Formal safety nets such as toll-free lines and SGBV shelters were not readily available, and social distancing and other PHSMs meant that informal supports such as family, friends, and neighbors were also more difficult to reach or access.⁷⁵  In a few communities, the NGO Save the Children supported litigation after the fact for children who had experienced some form of violence at home.⁷⁶  

In some communities in Mayuge district, community leaders and volunteers used community radios and megaphones to encourage community members not to engage in sexual and gender-based violence. They used the same tools to communicate with community members who had been assaulted, telling them where they could report crimes and access SGBV services. Where they were used, these services were associated with reduced reports of SGBV.⁷⁷

Psychosocial support

In some communities, Save the Children and other NGOs provided psychosocial support to clients through regular phone calls, home visits to families, and mini gamebooks and radio messages to reduce stress among children.⁷⁸  

Obuntu bulamu is an ongoing research collaboration started in 2017 by Ghent University and public and private partners to improve participation, inclusion, and quality of life for children with disabilities in Central Uganda.⁷⁹ This program implemented a peer-to-peer support intervention for those children—along with their nondisabled peers, parents, and teachers—in the Wakiso and Masaka districts in 2020.⁴⁰

Uganda’s extensive experience managing previous epidemics gave it a strong surveillance infrastructure designed to detect local transmission of disease outbreaks early enough to slow their spread.⁸⁰ This infrastructure included a national Integrated Disease Surveillance and Response (IDSR) framework that draws primarily from reports from community VHTs, staff at health facilities, and trained immigration staff at border points of entry (PoE).^71,81,82 The country also had preexisting short message system (SMS) reporting platforms and response structures.

Some of these capacities were more localized. In the areas most affected by recent Ebola outbreaks, for example, some VHTs were trained to perform infection prevention and control, epidemic surveillance, and other aspects of outbreak response.

At the beginning of the COVID-19 pandemic, Ugandan officials could quickly employ these preexisting tools and facilities to monitor the intensity, geographic spread, and severity of disease and mobilize surge capacity, internal resources, and external emergency support.

The UVRI, which played an integral role in supporting COVID-19 surveillance across the board in Uganda, also increased its genetic sequencing efforts throughout the pandemic. This research helped track COVID-19 transmission in the country and build models to further improve data-driven decision making.^{83,84 ,85,86}

Digital tools for COVID-19 surveillance

In 2017, Uganda’s MoH developed a National eHealth Strategy, which aimed to “harness and create an enabling environment for the development and utilization of sustainable, ethically sound and harmonized Information and Communications Technology at all levels to promote health and improve health services delivery in Uganda.”⁸⁷  According to one analysis, Uganda’s health system used 91 digital health tools as of 2021. Of these, 35 were adapted or developed for COVID-19 response.⁷³ Integration and interoperability of all systems with the National Electronic Health Information System was a persistent challenge.

Some of the tools that health authorities used to gather and share data for decision making during the COVID-19 pandemic are summarized in the table below.

Uganda had substantial laboratory infrastructure before the COVID-19 pandemic began (for testing and tracing for tuberculosis and HIV, for instance). Early in 2020, officials adapted some of this infrastructure to meet the new needs associated with the COVID-19 pandemic. The UVRI is a national reference and research center for the investigation of viral infections; its campus comprises five different laboratories, including the Vector Borne Disease Control Laboratory. Along with several other specialized laboratories, these were repurposed by the Central Public Health Laboratory for COVID-19 testing. Coordination among the various laboratories with different disciplinary strengths enabled collaboration with other countries and the standardization of testing procedures.

However, in Uganda as elsewhere, testing supplies were limited, especially early in 2020.¹⁰ As a result, the country’s testing strategy was targeted and risk-based.⁸⁸ Testing priority went to travelers from high-risk countries; some workers (such as truck drivers and traffic police officers) in border districts; symptomatic cases reported through community alerts; and contacts of confirmed cases, including those of health workers.³

At first, Uganda relied solely on polymerase chain reaction (PCR) tests, initially the only COVID-19 test the World Health Organization (WHO) recommended. Many health workers were familiar with these types of tests, which were already in use for HIV testing among infants, for instance.⁸⁹  These PCR tests had to be sent to accredited laboratories, including the UVRI, the National Public Health Laboratory at Butabika, Tororo General Hospital, and Makerere University College of Health Sciences Laboratory at Mulago, for analysis.¹⁰

Health authorities soon adopted GeneXpert testing, which they were already using to diagnose tuberculosis and other diseases, for truck drivers at border points. This point-of-care testing delivered quicker results than PCR tests, sometimes in less than one hour.^90,91

The country added rapid diagnostic tests (RDTs) to its official testing strategy in October 2020, and in December 2020 officials began to pilot RDTs to screen higher-risk people such as hospitalized patients, symptomatic health workers, and quarantined individuals.^92,93 During this pilot phase, RDTs were used exclusively for screening; results were reported to the national lab database only after PCR tests confirmed them.

By June 2021, at the peak of Uganda’s second pandemic wave, RDT kits were widely distributed across the country, and official guidance recommended that they be used to screen all symptomatic people—symptomatic contacts of confirmed cases, symptomatic people seeking care at health facilities, and symptomatic people in congregate settings like prisons. During this period positive RDTs did not require PCR confirmation.⁹⁴

In August 2020, Ugandan authorities implemented a $65 fee for some test seekers, such as asymptomatic people and truck drivers at the border between Uganda and Kenya. Officials reduced that fee to $50 in October 2020.⁹⁵ As of June 2021, health workers qualified for free testing (RDT or PCR) at public facilities, and free RDT testing was also provided at public health facilities for people seeking care.⁹⁶  Others who wanted testing, including asymptomatic people, still had to pay for tests at private laboratories or government testing centers.⁹⁷

Uganda’s limited, targeted testing strategy kept many infections undetected in the early part of the pandemic. Sample collection was allowed only at specific accredited sites, which forced some eligible people to travel long distances for a free test. Meanwhile, asymptomatic people—who were not eligible for free tests—may not have received them. In that case, they could not have known that they had contracted COVID-19, leading to underreporting and viral spread.

Even when tests were available, the stigma associated with testing positive for COVID-19 (one report even quoted health officials speaking of “hunting down” suspected patients⁹⁸) pushed some people to avoid them. This limited opportunities for early detection, treatment, and mitigation of viral spread.⁹⁹ Informants reported that there were times when the supply of free tests outstripped demand.

Because of these gaps in Uganda’s testing data, additional information—such as excess mortality and serological surveillance data—may help establish a clearer picture of the disease burden in Uganda. Researchers have been conducting seroprevalence studies for human coronaviruses at hospital sites in Uganda since before the COVID-19 pandemic began,¹⁰⁰ continuing through 2020 and 2021.¹⁰¹ Serological findings suggested a higher exposure to COVID-19 in the general population than testing data reflects.¹⁰⁰

WHO statistics on excess mortality showed more than 20,500 excess deaths in Uganda from the beginning of the COVID-19 pandemic through the end of 2021¹⁰² —far more than the 3,291 COVID-19 deaths officials registered.¹⁰³ This gap, too, may have reflected the country’s limited and targeted testing strategy. However, Uganda’s MoH disputed these figures.⁹⁴

As a result of its experience with previous epidemics, Uganda already had a contact tracing infrastructure and trained workforce in place before the COVID-19 pandemic began.

For instance, during the Ebola outbreak in 2018–2019, the National Task Force coordinated preparedness efforts and field response, including epidemiological surveillance. In the highest-risk districts, mostly along the country’s western border and around Kampala, rapid response teams provided disease surveillance training to health workers, VHTs, and others, including police and security forces. Volunteer screeners worked in health facilities, border PoE, refugee reception centers, and communities.¹⁰⁴ This work aimed to limit the importation and spread of Ebola in Uganda. Only four cases were reported—all of which officials believe were imported from a neighboring country—and no in-country infections or transmission.¹⁰⁵

Applying these tools, experience, and trained personnel, Uganda performed intensive COVID-19 contact tracing from March to September 2020. During this period, contact tracing occurred in a top-down fashion: central teams deployed to health regions worked with regional surveillance, case investigation, and case management teams. Contact tracers often used WHO’s Go.Data tool to collect patient data using mobile phones.¹⁰⁶

As COVID-19 case counts increased after the end of the national lockdown in May 2020, overwhelming the capacity of this centralized contact tracing strategy, in some districts local community health workers, volunteers, and students began to aid epidemiologists’ contact tracing efforts.²⁴ (Most were unpaid, but one report notes that some received stipends, training, T-shirts, and other incentives.)⁹⁹ This decentralized approach aimed to build community engagement and capacity and improve the efficiency of contact tracing in the COVID-19 context.

However, even as decentralized efforts expanded, challenges persisted. For instance, despite the many volunteers recruited to support the task, limited testing made it difficult to confirm cases and link them to a source of infection. Communication was delayed. Cases and contacts were sometimes uncooperative, perhaps due to the stigma associated with COVID-19 infection. Logistics were also a challenge: as one analysis notes, in some cases “contacts were not tested due to inadequate laboratory supplies, fewer contacts were followed up due to limited transport and some contacts were forced to use public transport to health facilities for sample collection which risks increased transmission of the virus.”²⁴

Prior to the COVID-19 pandemic, Uganda’s rates of immunization coverage were generally high: in 2020, the national rates of immunization against DPT3 and measles were 94% and 87%, respectively.¹⁰⁷ These immunization programs were mostly donor-funded.

A robust cold chain infrastructure is essential for storage and delivery of essential vaccines, including vaccines against COVID-19. In Uganda, with help from partners such as Gavi, the Vaccine Alliance and UNICEF, the National Expanded Program on Immunization had already begun to establish a functional cold chain system powered by electricity, solar, and LPG gas before the COVID-19 pandemic began.¹⁰⁸  In 2020, Uganda had 128 established district vaccine stores and approximately 3,213 health facilities equipped with cold chain equipment.¹⁰⁹

In December 2020, Uganda issued its first deployment plan for COVID-19 vaccines. This document outlined the country’s strategies to vaccinate vulnerable populations, ensure the availability of adequate and viable vaccines, train health workers to provide and manage the vaccination process, generate demand, and monitor the implementation of the vaccination program.¹¹⁰

Starting in March 2021, when Uganda received its first batch of COVID-19 vaccines from COVAX, the country’s vaccination campaign targeted high-risk groups: health workers, security personnel and other frontline workers, people older than 50, and people with certain comorbidities.¹¹¹However, the early vaccination campaign lagged. Reports indicate that initial efforts focused on just a few vaccination sites, mostly in cities; eligible people in rural or hard-to-reach locations had to travel long distances to find doses. Limited vaccine sites also meant long lines and, sometimes, supply shortages.¹¹²

Even though increasing the rate of vaccine coverage would enable the reopening of the economy and reverse some of the negative impacts of the PHSMs that Uganda had implemented to control COVID-19 spread, the country’s vaccination campaign was met with some hesitancy. One study found that majorities of participants lacked information about the COVID-19 vaccine and its availability in their districts. Some believed that officials should be immunized first. About 15% attributed their hesitancy to misconceptions that were relatively common worldwide, such as that the vaccine could cause infertility or infect recipients with COVID-19, or that COVID-19 was not a serious illness.¹¹²

Initially, the cause of low vaccination rates in Uganda was not vaccine hesitancy but the lack of vaccine availability.¹¹³ Starting in August 2021, when the country received more doses of vaccines, all Ugandans 18 years and older were eligible for vaccination. Even so, at that time, vaccines were still available mostly through designated health facilities where many eligible people could not access them. Later, authorities worked with local governments and NGOs to increase access via outreach programs and mobile vaccine sites.^107,114,115

By the end of December 2021, just 3% of Ugandans had received a complete dose of the COVID-19 vaccine, and 15% were partially vaccinated.⁹⁵

Case study: COVID-19 vaccine uptake in Uganda A study conducted in November 2021 by researchers at the Makerere University School of Public Health and the Massachusetts Institute of Technology examined the factors associated with COVID-19 vaccine uptake and intention to vaccinate in Uganda.116 Several key lessons arose from the study. 1.Health workers can be a key resource. Previous studies reported that health workers’ advice on vaccination was highly trusted.117,118 Consequently, providing health workers with accurate and sufficient public-health information to share with their clients and communities may boost vaccine confidence and uptake. At first, vaccine uptake among health workers themselves was reportedly low—even though they were a priority group from the start of the Ugandan vaccination campaigns. An in-depth study of health workers reported lack of trust in the vaccine, fear of side effects, not feeling at risk, lack of sufficient information about vaccines, health systems challenges, and religious beliefs as barriers to COVID-19 vaccination (see figure below).120 Researchers argue that when health workers receive a vaccine, they are more likely to recommend that their patients do the same.121 Health systems should address vaccine hesitancy among health workers if they are to be maximally effective champions for COVID-19 vaccination. Reasons stated for nonvaccination against COVID-19 in Uganda in November 2021 2. Health systems should disseminate accurate information as widely as possible. In Uganda, education status predicted vaccination status. This is not surprising, as it reflects the findings of previous research on vaccine acceptability.122,123  Further efforts are required to ensure dissemination of accurate information to people with lower levels of education, including via public health messaging in local languages. (See figure below.) Reasons stated for vaccination against COVID-19 in Uganda 3. Trust in health systems is a key determinant of vaccine uptake. Half of the study participants reported high levels of trust in the Uganda MoH’s handling of the COVID-19 pandemic, and a positive perception of their competence was associated with vaccination uptake. More generally, researchers have highlighted trust in government as a key determinant of uptake of public health interventions: studies from Nigeria,124 the Democratic Republic of the Congo,125 Brazil,126 Thailand,127 and China128 analyzed links between trust and compliance with PHSMs, and mostly found a positive association between trust and vaccination. In Uganda, study participants were more willing to adopt health officials’ recommendations to vaccinate than traditional leaders’. The MoH should intensify its vaccination education campaigns and make efforts to strengthen public trust via risk communication and community engagement. It should also work to increase access to COVID-19 vaccines across Uganda. 4. Health systems should make efforts to bridge the intention gap. The study found that the intention to vaccinate among unvaccinated people was much higher (91.0%) than it had been in a March 2021 survey (57.8%) conducted by the same research team.57 The high mortality that Uganda experienced during the delta wave129 could have contributed to this change. Respondents also reported a concern that at some point unvaccinated Ugandans would be denied health and social services, which could also have boosted their intention to be vaccinated. A November 2021 survey of 23,000 people from 19 African Union member states including Uganda found that 78% of respondents had either been vaccinated or were likely to get vaccinated (note that as of December 2022, less than 30% of Africans are fully vaccinated against COVID-19).130  The survey concluded that low vaccine uptake was due more to unpredictable supply of vaccines and logistical hurdles than reluctance or refusal to get vaccinated.127 Evidence suggests that strategies that bring vaccines closer to communities (such as extending vaccines to more health facilities, establishing mobile vaccination or service points, and conducting regular outreach) are likely to mitigate time- and transport-related barriers and increase vaccine uptake.131 ,132 In general, the study found that efforts are needed to increase access to vaccines, utilize health workers as a key information resource, and strengthen trust in the MoH. All of these should positively affect vaccine uptake as well as adherence to PHSMs.

During the early months of the pandemic, Ugandan health facilities stretched the capacity of their workforces by taking advantage of the ability of nonmedical staff to do essential jobs such as temperature screening at health facilities. MoH guidelines recommended shifting tasks such as temperature and symptom screening and some EHS to VHTs wherever possible.¹⁴³  

Task shifting among health workers was not a new practice in Uganda. In fact, to address the country’s persistent shortage of higher-skilled health workers, less-skilled workers have been delivering care to patients with HIV, tuberculosis, and malaria as well as EHS (such as maternal, newborn, and child health) at many levels of the system for generations.^144,145

During the COVID-19 pandemic, many health workers were redistributed to boost the maintenance of EHS and to provide services associated with COVID-19 prevention, surveillance, and care.¹⁰ In some districts, staff were recruited and redeployed to maintain EHS, while others were assigned to provide care at COVID-19 facilities. For example, health workers—including epidemiologists, doctors, anesthetists, nurses, laboratory technologists, psychiatric clinical officers, ambulance assistants, and drivers—were deployed on six-month contracts to COVID-19 treatment centers and to support districts and PoE in surveillance.

When possible, officials provided VHTs and other staff delivering in-person services with protective gear.¹⁴⁶ This practice also helped ensure the maintenance of critical community-based services such as indoor residual spraying (IRS) for malaria and mosquito control and integrated community case management of childhood illnesses.¹⁴¹

In addition to health services, CHWs also supported contact tracing and community education about COVID-19. However, movement restrictions limited these services to community members who lived near the homes of CHWs.¹⁴⁷ Finally, some health facilities provided safe accommodations, such as in hostels, for health workers during lockdowns. However, this practice was infrequent and not sustainable over the long term.¹⁴⁸

Where it was not possible to enable patients and providers to avoid health facilities via telehealth and other means, Ugandan authorities adapted preexisting facilities to facilitate the in-person delivery of both COVID-19 treatment and EHS. These separate facilities aimed to minimize contact between COVID-19 patients and patients seeking other kinds of health care and enabled service delivery at other levels of the health system.

As of July 2021, Uganda had 3,793 beds in health facilities for COVID-19 patients. 218 of these were intensive-care beds: 27 at the Mulago National Referral Hospital and the rest at regional referral hospitals (which had an average of 10 ICU beds each), military hospitals, and accredited private facilities.¹⁴⁹  In September 2020, the MoH converted parts of the Mandela (Namboole) National Stadium on the outskirts of Kampala into a field hospital planned to hold more than 1,000 people at a time. (Authorities expected it would treat mostly asymptomatic and mild cases in isolation.)¹⁵⁰  The stadium hospital closed as the surge waned, but reopened In July 2021 when the second wave increased case counts dramatically.¹⁵¹

To ensure rapid response to emergency COVID-19 cases, the MoH deployed a fleet of 50 ambulances for the Kampala metropolitan area, along the major highways and at selected regional sites from the end of December 2020 to the end of January 2021.¹⁵²

Officials also designated clinics for EHS delivery, such as young-child clinics for maternal and child health.

Service delivery was adapted in other ways as well. For instance, in the West Nile region, the Association of Volunteers in International Service Foundation and UNICEF secured official clearance for boda-boda motorcycle drivers to transport mothers and young children to health facilities for medical attention even when movement restrictions prohibited boda-bodas from carrying passengers. The NGOs trained the drivers on the MoH guidelines for COVID-19 prevention and control and gave them hand sanitizer and face masks.¹⁵³  Localized interventions like this one helped ensure the continuity of EHS delivery for mothers, newborns, and children.¹⁵⁴

To prevent stockouts of essential supplies such as PPE and diagnostic tools, health officials used preexisting national distribution mechanisms, procurement plans, and digital platforms such as eLIMS to enable the transfer of goods from one health facility to another.¹⁵⁵   By July 2021, with the help of partners such as USAID, Uganda had established a digital system for ordering and distributing key commodities (such as PPE, medicines, and oxygen supplies) to district health facilities.¹⁵⁵ The MoH’s Pharmacy Division reviewed family-planning procurement plans and asked the National Medical Stores to supply facilities accordingly.

Partnerships with organizations like the Global Fund, Africa Centres for Disease Control, WHO, and many others helped Uganda ensure continuous delivery of EHS¹⁵⁶ and boost local manufacturing of key goods such as PPE, reducing its overreliance on imports for health and related commodities.^157,158

In June 2021, Uganda’s National Drug Authority granted marketing approval of an herbal medicine, Covidex, to treat COVID-19 symptoms.¹⁶⁷ Most Ugandans were not yet eligible for the vaccine at that time, and reports indicated that the use of this and other herbal medicines to prevent and treat COVID-19, even among hospitalized patients, was widespread.^168,169

Note that treatment and care for COVID-19 was not a focus of this research.