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OPINION

By Shem Mwebaza

In 2018, the World Health Organisation (WHO) adopted Disease X on their shortlist of blueprint priority diseases to represent a hypothetical,
unknown pathogen that could cause a future epidemic (an outbreak of a disease in a particular location).

Disease X is already on the horizon, and could be far worse killing millions more people than the last epidemic. It is not known for certain what form it will take but its arrival, according to global health experts, is not just a possibility but a probability.

WHO experts believe that the lack of adequate preparedness within the international community to tackle this looming threat is concerning. Human movement has been the main source of epidemics throughout recorded history.

It is the pathway for disseminating infectious diseases throughout recorded history and will continue to shape the emergence, frequency and spread of infections in geographic areas and populations. The current volume, speed and reach of travel are unprecedented. The consequences of travel extend beyond the traveller to the population visited and the ecosystem.

When people travel, they carry along micro (invisible) and macrobiological (visible) life including diseases.

The transport sector in Uganda includes air, road, water and rail transport modes. Road transport is the mostly used form of transport carrying about 95% of the country’s goods and 99% of traffic.

It is further broken down into buses, taxis/matatus, bodabodas and special hires. Of these, taxis/matatus are easier and greater in numbers on the roads, they are more available on each road, including roads not used by buses. However, our road transport systems has public health concerns that we need to address.

1. Hygiene: From my experience, except for the basic removal of the visible dirt and disposed of materials by passengers during the vehicle washing process, public vehicles are not sufficiently cleaned or disinfected regularly.
2. The few times specific individuals do the disinfection, it is not properly done or does not follow any approved disinfection procedures. Reports of bedbugs, leftover food, vomitus, urine bottles and the like have been shared by various users. These kinds of situations require specific cleaning and handling to prevent spread of diseases and parasitic insects for example.
3. Poor ventilation: With the effects of COVID-19 still fresh on our minds, the need for proper ventilation in our public transport vehicles cannot be more emphasized. I have used taxis with sealed windows that cannot be opened. I am not sure why taxi owners chose to have some windows permanently closed but in my view whatever the reason could be, the benefits cannot outweigh the need for proper ventilation in such an environment.
4. Vehicle condition and sharp objects: One of the most common ways through which pathogens gain access to human bodies is through a damaged skin. Many of the vehicles used in public transport have sharp and piercing seats and edges that routinely cause harm to passengers one after another while the owners look on. As if this is not enough, the conditions of some of these vehicle and way they are driven makes the situation worse.
5. Seating and spacing: Although there are regulations and guidelines on number of passengers carried by specific public vehicles, the fact that we have different sizes makes it difficult. During the COVID-19 season, the number was revised downwards, indicating that the current numbers could be more that appropriate for maximum safety of passengers.

We shall continue to use the public transport system, but along the way we need to strive to continuously improve it. Disease X should find us better prepared and having used the lessons from COVID-19.

In that regard, there is an urgent need for minimum standards for all vehicles intended for and in use for public transport. The standards should specify the vehicle condition, ventilation and minimum required passenger spacing among other relevant requirements. In addition, we need to establish standard operating procedures for cleaning and decontamination of vehicles used for public transport. These standard operating procedures can specify how often cleaning and decontamination should be done.

The writer is on a public health fellowship programme; laboratory leadership fellow and laboratory health