'Public health gives you the chance to stop suffering before it starts': IPPHL Fellow Dr. John Kamulegeya

Dr. John Kamulegeya has been at the forefront of some of Uganda’s most critical national outbreak investigations and has helped the country’s Expanded Program on Immunisation introduce several life-saving vaccines into the country’s routine immunization schedule, including pneumococcal, rotavirus, measles-rubella, and most recently, the malaria vaccine. But his story began with a brush with mortality: born via cesarean section and placed in neonatal intensive care for birth asphyxia, he believes this experience helped instill a sense of purpose.

Initially envisioning a future working abroad, Dr. Kamulegeya’s path shifted during clinical rotations in rural Uganda. Witnessing preventable illnesses claim lives due to late diagnoses and lack of access to care, he began to see public health – and especially prevention through vaccination – as the most effective way to protect vulnerable communities. His early work in cervical cancer screening in rural Nakasongola district revealed both the potential and limits of clinical care in low- resource settings. “I realized that by the time most patients reached us, it was already too late,” he said. “I wanted to help earlier – before the illness ever arrived.”

That realization led him to epidemiology and, eventually, to the International Program in Public Health Leadership, hosted by the University of Washington’s Evans School of Public Policy and Governance. Dr. Kamulegeya credits the program with transforming his approach to leadership – from instinctive to intentional. “Before IPPHL, I didn’t know how to manage people, how to give feedback constructively, or how to build strong teams,” he said. “Now, I lead differently. I create space for others to contribute. And the outcomes have been better because of it.”

In this conversation, Dr. Kamulegeya, who is currently an advanced field epidemiology fellow with the Uganda Public Health Fellowship Program and a member of the country’s national Adverse Events Following Immunization Causality Assessment Committee, shares lessons from Uganda’s COVID-19 response, his insights into what it takes to improve vaccine uptake in low-resource settings, and his hope of one day contributing to the elimination of polio, measles, and malaria from the African continent.

Could you tell us about your personal journey? What inspired you to pursue a career in public health and epidemiology, and how did your interest in vaccine-preventable diseases develop?

Dr. Kamulegeya: First of all, I’m Ugandan – I was born in a national hospital. Growing up, my mother would often tell me that I spent the first two weeks of my life in a neonatal intensive care unit. I was the only one of nine children born via cesarean section.

Before university, I always thought I would study and then go work outside Uganda. I had friends working abroad, and I aspired to follow in their footsteps. But once I got to medical school, I started to understand more about what had happened to me at birth. I learned that I had suffered from moderate to severe birth asphyxia following cord prolapse, which explained my time in the ICU. That realization shifted everything for me. If there hadn't been doctors there to help my parents, I wouldn't be alive today. That made me think differently – this wasn’t just about me anymore. I needed to help others, especially those in places where help was most needed.

During my training, I was especially impacted by the community placements and electives in rural hospitals. I saw firsthand how much need there was for medical care in our own communities. Later, when I worked at Nakasongola district hospital, I led the cervical cancer screening program. There were only two doctors in the district – myself and another who focused on management – so I was the main clinician. We screened more than 2,000 women, and about 7% had pre-cancerous lesions. These were treatable. But in my clinical work, most of the patients I saw had already progressed to late-stage cancer, when all we could offer was palliative care.

That contrast really struck me. In clinical care, I could only help people once they were already sick. In public health, I could help prevent that suffering altogether. That’s what led me to shift from clinical work to public health – and then to epidemiology. I’m proud to say my work has had an impact not only in Uganda but also in Nigeria, Zimbabwe, Malawi, Tanzania, and Somalia. Through public health, especially in vaccine-preventable diseases, I’ve been able to help prevent illness and death on a much larger scale.

Can you share your experience working with Uganda’s National Expanded Program on Immunization (UNEPI)? What initiatives have you contributed to, and what impact have they had?

Dr. Kamulegeya: During medical school, we didn’t have much training on immunization. But in my clinical practice, I began working with UNEPI, and that experience has been incredibly enriching. I’ve led national-level outbreak investigations for diseases like cholera, measles, yellow fever, and malaria. Over the past ten years, I’ve supported the introduction of multiple vaccines into Uganda’s routine immunization schedule, including pneumococcal, rotavirus, measles-rubella, and most recently the malaria vaccine. I’m currently part of the national team supporting the introduction of the malaria vaccine. I also serve as a member of the Uganda’s National Adverse Events following Immunization Causality Assessment Committee, helping shape vaccine policy and surveillance. It’s been a privilege to contribute at this level, knowing that these efforts are saving lives across the country.

You played a role in Uganda’s national COVID-19 response, supporting 17 districts. What were the biggest challenges you faced, and what lessons did you learn?

Dr. Kamulegeya: Before Uganda recorded its first COVID-19 case, I was part of the screening and surveillance team at the national airport. Later, I became epidemiologist for the Ankole region, covering 19 districts. One of the biggest challenges was the shortage of personal protective equipment, especially for frontline health workers. We lost colleagues – people died while trying to save others. That was incredibly painful.

Another challenge was the constant evolution of guidelines and protocols. Surveillance teams were at high risk of exposure, and I lived in fear of infecting my family. I took infection control measures very seriously. One of the most important lessons I learned is that managing public health crises requires deep community involvement. Initially, the response was led mainly by doctors and clinicians, but that wasn't enough. When the president addressed the nation on radio and TV every week, the public took the guidelines more seriously. That showed how powerful proactive, consistent communication can be.

Another key lesson was the importance of getting ahead of misinformation. Too often, we waited to respond to negative media coverage. Going forward, we need to lead with clear, timely messaging rather than playing catch-up.

Could you tell us about your experience with the IPPHL program? How has the training helped you navigate leadership challenges in immunization and outbreak response?

Dr. Kamulegeya: Before IPPHL, I had never received formal training in management or leadership. Undergraduate medical school taught very little about leading teams, cultural awareness, and managing systems. IPPHL was my first real exposure to that kind of training. It helped me understand what kind of leader I am and, importantly, how to give feedback effectively. In the past, I gave feedback based on how I felt in the moment, without thinking about how it might be received. Now, I think more intentionally about timing, tone, and context.

Through the program, I also got feedback from both my juniors and seniors on my leadership style – what I was doing well and where I could improve. That was eye-opening. I’ve become more collaborative. I still lead, but I now make more space for others to contribute ideas. That shift has made my teams stronger and more cohesive.

What lessons from the program would you share with other global health professionals looking to improve vaccine coverage in Africa?

Dr. Kamulegeya: As part of my IPPHL training, I wrote a policy memo on HPV vaccination uptake among adolescent girls in Uganda. I found that many of the barriers were unique to our context – cultural, logistical, and community attitudes. That experience taught me that we can’t just apply strategies that worked elsewhere. Every country, every region, has its own realities. We need to contextualize our approaches – understanding who we’re serving, how to reach them, when, and with what messages. That cultural and local sensitivity is critical.

You’ve worked extensively on outbreak investigations and vaccine policy. What advice would you give to policymakers working in low-resource settings?

Dr. Kamulegeya: My advice would be: do your own research and ask your own questions. Don’t just wait for strategies from outside – develop solutions that fit your environment. Community-based and operational research is key. If you understand your people and their needs, you can design immunization strategies that are more effective, more accepted, and more sustainable.

Finally, how do you see your work evolving over the next 5 to 10 years? Are there specific health issues you want to focus on?

Dr. Kamulegeya: I think we all want to leave a legacy. For me, I want to be part of the team that eliminates polio, measles and malaria in Africa. These diseases are still among the leading causes of death and illness. If we can eliminate them, we’ll save countless lives – and save resources at both national and individual levels. That’s where I want to be: working hard to eliminate the major diseases that continue to burden our continent.