MUGWE: Ebola quarantine facility: Defending the indefensible

But one man did the opposite. Physician John Snow walked toward the outbreak, mapped every death street by street and traced the source to a single contaminated water pump on Broad Street.

He removed the handle. The outbreak stopped. Not because Snow was reckless, but because he understood that proximity, managed with intelligence and discipline, is the only effective response to a contagion that does not respect the distance of those who refuse to engage it.

What Snow did is what Kenya's Laikipia quarantine debate should be about. Not whether to be brave or reckless, or to be America's servant or Africa's guardian.

But whether we understand the difference between managed proximity and unmanaged vulnerability, and whether we have the strategic clarity to choose between them before the choice is made for us.

Hundreds of people exercised their constitutional rights in Nanyuki and demonstrated against the establishment of the Ebola quarantine facility at the Laikipia Air Base for American citizens exposed to the virus, two days after the High Court suspended the facility pending a case filed by the Law Society of Kenya and Katiba Institute.

The leadership in Laikipia was equally unambiguous in their stance, and many Kenyans on social media expressed the same outrage at this proposal.

It is easy to understand why Kenyans are uneasy. Ebola is not an ordinary disease. It evokes fear, isolation, death and memories of pandemics where ordinary people were asked to trust systems that did not always explain themselves well.

These fears deserve to be taken seriously, not dismissed. A quarantine facility for a haemorrhagic fever with no approved vaccine and a case fatality rate between 30 and 50 per cent requires the most rigorous biosafety standards, the clearest legal framework and the most transparent public process available.

At least 263 confirmed cases of the Bundibugyo virus, a rare strain of Ebola for which there is no approved vaccine or treatment have been reported in DRC. Uganda has reported nine cases and closed its border with DRC. Kenya has activated its Public Health Emergency Operations Centre and intensified surveillance at border crossings, given the frequent movement between Kenya and Uganda.

The threat is not hypothetical. It is next door where we share trade routes, trucking corridors, family connections and the quiet daily movement of people that no government decree fully controls.

But fear, by itself, cannot be our foreign policy. Suspicion, by itself, cannot be our public health strategy. And outrage, however justified at first sight, cannot be the only language through which Kenya negotiates its place in a dangerous world.

Begs the question. Should Kenya proceed with the establishment of this facility?

I submit that we are asking the wrong question. The real question is not whether Kenya should prepare, but whether we should prepare from outside the room or from inside. And the answer is simple. Kenya must be in the room and at the table because although we are not currently affected, we are not currently isolated either.

On December 4 last year, Kenya and the United States signed a five-year Sh2.5 billion Health Cooperation Framework where the United States plans to support HIV/AIDS, tuberculosis, malaria, maternal and child health, polio eradication, disease surveillance and infectious disease outbreak response and preparedness.

The framework explicitly commits both governments to detect, prevent and respond to emerging and existing infectious disease threats affecting both countries.

Kenya is also bound by the International Health Regulations, which require countries to develop the capacity to prevent, detect, assess, report and respond to public health emergencies.

Global health diplomacy is not a slogan. It is the practical recognition that diseases of international concern cannot be managed by hiding behind national borders, but through cooperation.

Therefore, a quarantine facility for people exposed to an active Ebola outbreak, staffed by the United States Public Health Service Commissioned Corps, equipped with state-of-the-art biocontainment technology, operating under Kenyan law and on Kenyan soil, is precisely what that framework anticipated.

The risks are clear. But we must do it anyway because the argument for its establishment is right, and because being right in a moment when everyone is retreating due to fear is exactly when the argument needs to be made most clearly.

Here is the argument that should be made in every cyber and Nanyuki street and at every bilateral negotiation table.

The Laikipia facility, if properly negotiated, transparently governed and legally anchored, should not be merely a place where foreigners are quarantined. It should be a down payment on Kenya’s health security architecture.

But that is only defensible if the quid pro quo is clear. Kenya should not carry reputational and public health risk while others carry the knowledge, skills, information, technology and vaccines. The facility should serve Kenyans and the region too, not just Americans. And that should be the non-negotiable principle.

Kenya has been listed among 10 African countries at high Ebola risk. The warning comes against a difficult backdrop where Kenya operates only three BSL-3 biosafety laboratories nationwide, and where there is no approved vaccine or treatment for the Bundibugyo strain. So, the question is not whether Ebola will test Kenya's preparedness. It is when. And when it does, will Kenya be prepared?

Our three national laboratories capable of testing for Ebola have the capability of releasing results within six to eight hours of receiving a specimen, for a country of 55 million people.

During Covid-19, Kenya was sending samples as far as South Africa to get results. That gap between a confirmed case and a confirmed diagnosis is precisely where outbreaks become epidemics.

This is what we need to demand to move the needle. This facility must not be for Americans only. The Katiba Institute is right that Kenya appears to have been selected as an alternative containment site for America's nationals.

But the remedy is not to oppose the facility. It is to expand its mandate. Any agreement governing the Laikipia installation must explicitly provide that Kenyan citizens and nationals of East African Community exposed to or infected with Ebola are treated at this facility and at the same standard as American nationals.

Secondly, should be knowledge transfer. The Laikipia facility is a knowledge transfer opportunity of extraordinary value.

Every Kenyan health worker who trains alongside those teams, every protocol shared, every technology demonstrated, every biosafety standard transferred will be permanent upgrades to Kenya's own capacity that survive long after the Ebola situation is contained.

The third demand should be replication. One facility at a remote military airbase is not a health system. Kenya should use this opportunity to negotiate the establishment of isolation and treatment infrastructure at Kenyatta National Hospital, Coast General Teaching and Referral Hospital, Jaramogi Oginga Odinga Teaching and Referral Hospital and Moi Teaching and Referral Hospital.

These four nodes, corresponding to Kenya's major population and transit corridors, would give the country the geographic coverage where future health crises can be responded to and contained in a timely manner.

The fourth demand is access to the vaccine pipeline. The cooperation framework includes provisions to drastically reduce the time taken to introduce life-saving medical countermeasures during a disease outbreak, in support of Kenya's 7-1-7 public health response target.

There are currently several Bundibugyo-targeted vaccine candidates in development which include pathogen data sharing provisions.

That data has priceless value. Kenya, as the host of the primary containment facility for this outbreak, and as a data-sharing partner, has a legitimate first-access claim to any successful vaccine candidate. That claim must be made explicitly in writing as a precondition of the facility's operation.

The fifth irreducible minimum should be that the rest of the world must resist the lazy reflex of punishing Kenya for doing the responsible thing. If Kenya agrees to host an Ebola quarantine and preparedness facility under clear safeguards, it should not then be punished through travel advisories and headlines that make us sound like an outbreak zone.

That would be the height of bad faith. A country that accepts shared risk in order to strengthen regional and global health security should be celebrated, not stigmatised.

Fellow Kenyans, the choice should not be between safety and risk. It should be between managed, resourced, legally grounded engagement on Kenya's terms, with Kenya not just as a gracious host, but as the primary beneficiary.

Finally, my unsolicited advice is to the sceptics and critics. Your vigilance is this country's immune system. Keep asking the questions. But distinguish between demanding better terms and refusing the table altogether.

East Africa is home to 170 million people and prone to frequent outbreaks of viral haemorrhagic fevers which mostly happen in remote areas where requisite laboratory capacity is unavailable, causing significant diagnostic delays and allowing epidemics to emerge.

Kenya has the geography, the infrastructure and the partnership frameworks to become the regional anchor of East Africa's health security architecture. The Laikipia facility is the opening offer in that negotiation. Refusing it is not strength. Accepting it on inadequate terms is not wisdom. Transforming it into a regional health security platform that serves all, is strategy.

Snow’s actions were not risk free. They were the systematic comparison of managed and understood risk against the unmanaged, uncontrolled risk of doing nothing in the face of the outbreak. Kenya is at the same decision point.  

Fear asks, ‘why here?’ Preparedness asks, ‘what happens if it reaches here?’ - Unknown