COVID-19 and the Law in Uganda: Development and Application of the Public Health Act to Control the Pandemic, 2020-2021

doi:10.21203/rs.3.rs-1396417/v1

Download PDF

Research Article

COVID-19 and the Law in Uganda: Development and Application of the Public Health Act to Control the Pandemic, 2020-2021

https://doi.org/10.21203/rs.3.rs-1396417/v1

This work is licensed under a CC BY 4.0 License

Version 1

posted

You are reading this older preprint version

Read the latest preprint version →

Despite the discovery of vaccines, control and prevention efforts relied on non-pharmaceutical interventions (NPIs) for the novel Coronavirus disease 2019 (COVID-19). This article describes the process of development and application of the public health law in prevention and control of the COVID-19 pandemic in Uganda.

Methods: A process evaluation of Uganda’s experience with enacting COVID-19 Rules. Briefly, the Public Health Act Chapter 281 (1935) was reviewed each time there was a revision of the NPIs during the COVID-19 outbreak. The study assessed how and what rules were developed, their influence on the outbreak progress and cases of litigation. The data sources were applicable laws and policies, Presidential speeches, cabinet resolutions, statutory instruments, the COVID-19 situation reports and registry of court cases that contributed to a triangulated analysis.

Results: Uganda applied four of COVID-19 broad Rules for the period March to October 2021. These Rules were amended twenty–one (21) times realigned along the pandemic curve, had an expiry period, and were preceded by Presidential pronouncements and directives. The Minister of Health enacted the Rules which were followed by response teams, enforcement agencies, and the general population. The enactment of COVID-19 Rules was necessary but not sufficient to control the pandemic, hence other laws came into play, specifically the Uganda Peoples Defense Forces Act No. 7 of 2005, the Public Finance Management Act No. 3 of 2015, and the National Policy for Disaster Preparedness and Management. Enacting COVID-19 Rules attracted specific litigation arising from perceived infringement on certain human rights provisions.

Conclusions: It is possible for low-income countries to enact supportive legislation within the course of a COVID-19 outbreak. The balance of human rights infringements would be an important consideration in future studies.

Public Health Act

Rules

Regulations

Uganda

COVID-19

Pandemic

The novel Severe Acute Respiratory Coronavirus (SARS-COV-2) causing the Coronavirus Disease (COVID-19) outbreak was reported in Wuhan, Hubei China in December 2019 (1, 2). By March 2020, the World Health Organization declared COVID-19 a Public Health Event of International Concern (3) and later a pandemic (4). Further, the first case in Africa was documented in Egypt on 14th February 2020, whilst in Uganda it was on 20th March 2020, at Entebbe International Airport. Due to the extreme ability for the virus to spread widely, several countries used the domestic and international laws to respond to the outbreak (5–10)

Uganda mainly applied the Public Health Act Chap. 281 of the laws (Public Health Act) of the Uganda to respond to the COVID-19, particularly for the Non-Pharmaceutical Interventions (NPIs). The Public Health Act is the governing law implemented by the Ministry of Health and section 5 authorizes local governments to enforce all provisions to ensure promotion of public health. Article 189 (Sixth Schedule) of the 1995 Constitution of Uganda outlines governments responsibility for health policy, control and management of epidemics and disasters. Equally, section 179 of the Local Government Act Chap. 243 (second schedule) authorizes the local governments to prevent and control diseases outbreaks. Consequently, the Public Health Act, in Part V assigns the role of prevention and control of epidemics and pandemics to the central government.

In October 2019, Uganda accelerated amendments to the Public Health Act with the aim of domesticating the WHO International Health Regulations (2005) (IHR 2005) and adapting current practices in response to public health emergencies. The Act is similar to public health laws of other African countries in the Commonwealth (Kenya’s Public Health Act, Chap. 242; South Africa’s Public Health Act, 36 of 1919; Zambia’s Public Health Act, Chap. 295; Malawi’s Public Health Act, Chap. 34:01; Botswana’s Public Health Act, Chap. 63:01 and Zambia Public Health Act, Chap. 295). Uganda is already implementing the national technical guidelines for Integrated Disease Surveillance and Response (IDSR), which incorporates the IHR 2005 (11). However, since these IDSR guidelines are not part of Uganda‘s legal framework, they are not legally binding, more so during response to public health emergencies (12).

Although Uganda had not completed this amendment process, the COVID-19 pandemic demanded legislation to legally implement control measures. Sections 10, 11, 27 and 36 of the Public Health Act required that the Minister of Health implements the health measures listed therein by enacting subsidiary legislation or Rules. There is scarcity of information on the process undertaken to develop the COVID-19 Rules and the subsequent application in response to control and prevention of the pandemic in Uganda. This paper describes the process of development and application of legal frameworks in responding to the COVID-19 pandemic in Uganda. This information can guide other countries on how to use laws to control infectious diseases.

This case study documents Uganda’s experience with amending the Public Health Act Chapter 281 (enacted in 1935), the attendant Rules that guided COVID-19 control, using a process evaluation approach. This study defined ‘a case’ as the ‘process of changing the Rules’ after a Presidential Address with health measures for public health action. In addition, this study assessed how the Rules, other supporting laws and policies were applied covering the period from March 2020 to October 2021. The primary assessments of interest in this study were legal: NPIs, Rules signed, lawsuits heard, and court decisions made.

Document review

The study reviewed primary data sources such as the Presidential Addresses on COVID-19 measures, Ministerial letters, Public Health Act, Uganda Peoples Defence Forces Act (UPDF Act), Disaster Management Policy, Public Health Rules, health and security operational guidelines, rules issued by other public authorities and court cases related to health and health emergencies. These were used to capture data related to other legislative provisions that supported the response. In addition, situation reports were reviewed to extract number of cases and deaths due to COVID-19 in relation to the dates when the rules were passed.

Context of the legal regime in Uganda

Uganda is part the Commonwealth, hence applies Common Law. The country gained her independence from Great Britain in 1962 and currently the 1995 Constitution (13) is the supreme law. Sections 14 and 15 of the Judicature Act state that the applicable laws are written laws or statutory laws, customary laws, common law and doctrines of equity (14). There are three arms of government (13) that is the Executive (the President and the Cabinet of Ministers); Parliament or legislature and Judiciary. All the arms of Government participate in the making of laws. The principal laws or Acts of Parliament are made with the approval of the Executive and Parliament. The subsidiary laws or statutory instruments for example Rules are mainly made by the responsible Cabinet Minister. The Judiciary makes the case law through judgements of court cases.

During the study period, Uganda experienced two peaks (waves) of COVID-19, with over 120,00 cases and over 3,000 deaths. The Public Health Act mandates the Minister of Health and the local governments to implement the Act. However, notification, suppression, and prevention of an infectious diseases into Uganda are implemented using subsidiary laws made under the Act. The Public Health Act gives the Minister of Health power to make Rules and Orders under sections 11, 27, 29 and 36 respectively. These Rules are recognized as law under Section 14 of the Interpretation Act and form part of the legal framework of Uganda (12). In order to prepare and respond to the COVID-19 pandemic, the Minister made several Rules and Orders by publication in the Government Gazette.

The process of preparing the Rules

The process for preparation of the Rules and Orders is under the Public Service Standing Orders, 2010 under the Public Service Act No 9 of 2008. Additionally, the paragraph (Q-b) in the Public Service Standing Orders, provides the process for making statutory instruments. The steps followed for development of the COVID-19 Public Health Rules are illustrated below (Figure 1). Once the President provided guidance (15) on control measures, the Ministry of Health prepared the proposals like closing schools, closing places of worship, restricting entry into the country and so on. The Minister of Health forwarded the drafting instructions to the Directorate of the First Parliamentary Counsel at the Ministry of Justice and Constitutional Affairs. The Drafting Team comprised of the Ministry of Justice and Constitutional Affairs and the Ministry of Health was constituted. The team reviewed the enabling provisions in the Public Health Act and other related laws in Uganda. Following this, the Drafting Team met with Ministry of Health outbreak response team to consult on the examination, quarantine, admission/isolation of COVID-19 patients and other control options before the final drafting. The Drafting Team also reviewed the Presidential Address for policy guidance on the response to the COVID-19 pandemic. However, the Drafting Team continuously sought clarification on some of the health measures in the Presidential Address for example the difference between arcades and shopping malls; the age limit for going to church and the health restrictions for open-air versus in-door places of worship. Subsequently, the Drafting Team shared the Rules with the Minister of Health for approval. This led to the Attorney General’s approval to publish the Rules in the Government Gazette, and upon publication the Rules become applicable law (Figure 1).

Presidential speeches and directives on COVID-19

The President pronounced 35 public health measures to control the spread of COVID-19 (15). These included controlled movement of vehicles, vessels, aircrafts; closure of international borders (except for cargo); closure of education facilities; closure of places of prayers; curfew and mandatory wearing of facial masks. Using the process of the making subsidiary laws, Uganda was able to develop 21 Rules under the Public Health Act. Other than the Public Health Act, two principal laws and one policy were applied to control COVID-19. Similarly, below is the discussion on the Public Health (Notifiable Diseases) on Declaration of COVID-19 as a notifiable disease; Control of COVID-19; Health measures at the Points of Entry and Prohibition of Entry into Uganda. In addition, the court cases relating to COVID-19 preventive measures up to October 2021 are presented below.

Declaration of COVID-19 as a notifiable disease

COVID-19 was not listed among the notifiable diseases in the Public Health (Notifiable Diseases) Order Statutory Instrument 281–22. The Minister of Health made the Public Health (Notification of COVID-19) Order, No. 45 of 2020 which declared COVID-19 a notifiable disease for purposes of the Public Health Act. The Statutory Order made under sections 11 (power to make Rules), Part IV (prevention and suppression of infectious diseases) and section 36 (Power to Enforce Precautions at Borders) of the Public Health Act applicable to controlling COVID-19(16). Section 11 of the Public Health Act places responsibility of reporting on the heads of a family; employers; heads of schools and local authorities. These persons are supposed to report any case of COVID-19 to the medical officers (Table 1).

Control of COVID-19 Rules

Following the declaration of COVID-19 as a notifiable disease, sections 11, 27 and 36 of the Public Health Act became applicable to the response. The Rules enforcing section 11 and 27 were published as Public Health (Control of COVID-19) Rules (17). They provided for notification to the medical officer or medical practitioner; for the admission of COVID-19 patients to government owned medical facilities; quarantine; searches of premises for COVID-19 patients; decontamination of premises; closure of education facilities; closure of places of prayers; closure of bars, restaurants, cinemas; lockdown; curfew; restrictions on passenger motor cycle movement; wearing of masks; restrictions on gatherings like political rallies; restrictions on marriage ceremonies, vigils; prohibition of spitting in public spaces; measures on asymptomatic persons and measures on infected areas or districts. The Rules have been amended 12 times depending on the level of the COVID-19 outbreaks. For instance, the Rules on opening and closing of schools; closing and opening places of prayers; imposition of curfew; enforcing lockdown and restrictions on movement of passenger motorcycles were continuously amended.

Health measures at the Points of Entry

In addition, an Order to control entry into Uganda was made under section 36 of the Public Health Act; this is the Public Health (Prevention of COVID-19) (Requirements and Conditions of Entry into Uganda) Order (18). The Order prohibited entry into Uganda through all points of entry. Also, the Order categorized the persons entering Uganda and how the travelers would be handled after examination for COVID-19. The Order introduced additional health measures like institutional quarantine or isolation of travelers entering Uganda. Hence, the Order was amended and revoked depending on the level of the COVID-19 outbreak.

Prohibition of Entry into Uganda

The Public Health (Prohibition of Entry into Uganda) Order, 2020 was enacted to close the borders of Uganda. The Order restricted the numbers of persons entering Uganda and these were amended five times until when borders were opened. The Order gave powers to the medical officer of health to examine any cargo vehicle, vessel or aircraft and any persons onboard.

Other legislative provisions applied for COVID-19 response

Other than the Rules under the Public Health Act Cap 281, the UPDF Act 2005 (19) was also applied. Due to the nature of the pandemic, there was a national security concern which necessitated the involvement of the Army under section 42 of the UPDF Act. This section empowers the Army to appoint its officers to work with any part of Government to control any event that is likely to cause a national disturbance. Therefore, the Army was involved in the enforced of the COVID-19 Rules at the international borders and in the appointment the COVID-19 Incident Commander. Similarly, COVID-19 outbreak happened in the middle of the financial year hence, the Ministry of Health had to get supplementary funding under section 25 of the Uganda Finance Management Act, 2015 (PFMA) (20). The application of the UPDF Act and PFMA to control the COVID-19 outbreak was based on its characterization as a disaster that could likely develop into a situation that requirement multi-ministerial action. Additionally, the national policy for Disaster Preparedness and Management, 2010 (21) of the office of the prime minister was implemented. The Policy provides for the way government should cooperate in the case of a pandemic like an influenza pandemic that spreads very fast due increased global travel. Again, the policy lists the Ministry of Health; the Office of the Prime Minister (Disaster Management); Ministry of Internal Affairs (Immigration and Policy); Ministry of Defense (Uganda Peoples’ Defense Forces); Ministry of Information and National Guidance; Ministry of Local Government and District Local Governments as the institutions that should partner to control a pandemic.

Court cases arising from COVID-19 preventive measures

As a result of the restriction and controls under the COVID-19 Rules several cases were filed against the Attorney General. The Public Health (Control of COVID-19) Rules imposed the restrictions on cinemas, theaters, business premises, places of worship, political rallies and so on. The case of Theatrical Association of Uganda and Another versus the Attorney General (Misc. Cause 369 of 2021) challenged closure of entertainment centers and open-air concerts. Also, the case of Kiganda Michael versus the Attorney General (Constitutional Petition No. 20 of 2021) contested the closure of places of worship or prayer. Again, the case of Tumuheirwe Arthur versus the Attorney General (Misc. Cause No. 382 of 2020) in which the closure of business premises was challenged. Equally, the case of Mgugu Abbey versus Electoral Commission and the Attorney General (Misc. Cause No. 63 of 2020) based on the restrictions on political activities. Following the Public Health (Control of COVID-19) (No. 2) Rules, the case of Turyamusiima Geoffrey versus the Attorney General and Dr. Jane Ruth Aceng (22) was filed in court contesting the fact that the legal services were not among the listed essential services in Rule 8. This led to the amendment of the same law through statutory instrument No. 64 of 2020; in which Rule 8 was amended to include the legal services with some restrictions. Additionally, the case of Male H. Mabirizi versus Attorney General (Misc. Cause No. 193 of 2021) challenged the implementation of presidential directives without enactment of any Act of parliament or statutory instruments.

Influence of preventive measures on public compliance and outbreak progress

The public health measures had an influence on the speed of getting new cases, geographical spread, and mortality from COVID-19 in Uganda. Compliance in the population was high with enforcement by security agencies (23). Figure 2 (not on scale) shows dates when the Rules were enacted, Statutory Instrument number, the number of cases and deaths recorded at the time. There was delay in spread of COVID-19 over time.

Principal findings

This study highlights five key findings. First, Presidential speeches were an effective medium for delivering COVID-19 public health messages (Non-pharmaceutical Interventions) to the public. However, these pronouncements and directives were not law in Uganda thus the need to enact public health Rules for enforcement. Secondly, the declaration of COVID-19 under the Public Health Act was key to implementing the NPIs. Third, enactment of COVID-19 Rules was necessary but not sufficient to control the pandemic, hence other laws came into play. Fourth, the NPIs evolved along the pandemic curve and there was need to realign the COVID-19 Rules frequently as appropriate. Finally, enacting COVID-19 Rules attracted specific litigation and somewhat infringed on certain human rights provisions.

Findings in relation to other studies

Uganda was one of the first in sub-Saharan Africa to enact COVID-19 specific laws as early as the 17^th of March 2021. Noteworthy, Uganda had previously successfully contained several highly contagious disease outbreaks like Cholera, Yellow Fever, Ebola Virus Disease, and so on (24), (25, 26), without necessarily enacting special laws that bring into question whether special laws were required in the first place. In fact, the last time Uganda applied section 27 of the Public Health Act to control diseases was in relation to plague in the 1980s, namely, the Public Health Rules (Plague Control), Statutory Instrument 281 – 27. What was unique in Uganda, however, was that these were preceded by high-level political commitment with Presidential COVID-19 pronouncements and directives, which weren’t law, and thus enacting Rules legalized these measures.

Countries could share best practices about processes of developing Rules to implement the legal framework during the height of a public health emergency. The application of laws to respond to the COVID-19 outbreak was also seen in other countries in sub-Saharan Africa (6 2021) such as South Africa (27), Kenya (28) and Botswana (29) in late March and April 2021. Higher income countries including China in Asia (30), New Zealand in Oceania (31) , United Kingdom in Europe (32) and USA in the Americas (33) did the same too. While some countries issued subsidiary legislations under their public health principal law, others enforced related laws. For instance, a subsidiary legislation was passed under the Kenyan Public Order Act to enforce curfew, that is, the Public Order (State Curfew) Variation Order (34) in April 2020. In June 2020, Trinidad and Tobago, the Public Health [2019 Novel Coronavirus (2019-nCov)] (No.12) Regulations, 2020 (35) were passed under the Public Health Ordinance, Ch. 12 No. 4.

The Rules imposed restrictions on public gatherings, hours of business operations, casinos, cinemas, theatres, gyms, school establishments, and restaurants. The same Rules provided guidelines on quarantine, treatment of COVID-19 patients, closed Trinidad borders, and prohibited testing in private medical laboratories. In China, laws were used to enforce compliance and control the spread of COVID-19. The Chinese government used experts to make COVID-19 specific laws under the Chinese Criminal law (30) that made it an offense for a person to violate laws on the prevention and control measures against COVID-19. The COVID-19 Rules were dynamic with “sunset provisions” of expiry, aligned to the evolving epidemic curve. These frequent amendments (21 in Uganda) of the COVID-19 Rules defied the principle of predictability of laws, “Stare decisis”. This observation was consistent in South Africa using the Disaster Management Act 2002 to develop, implement and amend several core Rules depending on the five levels of epidemic alertness (36). Although the provisions in the Public Health Act 1984 (Control of Disease) were seemingly adequate at the start (37), the United Kingdom enacted a new Coronavirus Disease Act, 2020 (38) that was reviewed often to add, remove or renew provisions as an outbreak evolved. Some of the COVID-19 preventive health measures (NPIs) directly restrained human rights such as the right to education (Article 30), the right to practice any religion (Article 29), and right to move freely throughout (Article 29), to enter, leave and return to Uganda. This scenario was prevalent globally and not in Uganda alone (39). Noteworthy, these COVID-19 preventive measures became more stringent as the outbreak evolved with increasing cases and deaths, such as community quarantine or total “lockdown” (40). Perhaps, it is the perception of infringement of human rights that triggered litigation in courts of law in Uganda, Kenya (41), Southern Africa (42), UK (43) and the USA (44).

Overall, decisions of court upheld the provisions of COVID-19 Rules across different jurisdictions. The cases filed in Ugandan courts challenged the implementation of the presidential pronouncements, some of which received judgement by the time of this study. In Uganda, while the Courts upheld the Rules in the case filed to permit political rallies; they favored the case of reclassifying more professional groups. For example, the Legal fraternity classified as essential workers thereby increasing the number of people on the streets. Similar studies elsewhere documented court cases filed during COVID-19 peak outbreaks and after control (45). In some of the cases, the courts at the beginning of the pandemic rejected challenges to COVID-19 emergency orders but later on supported them (45). For instance, in the United States of America recommended active review of the role of policies in evidence-based decision-making during outbreaks (45, 46).

Strengths and limitations

In terms of strengths, this study is one of the first to employ a legal perspective in documenting the enactment of Rules during pandemics or epidemics in a low-income country. In addition, this study employs multiple sources of data to corroborate the findings such as Presidential speeches, resolutions of Cabinet meetings, Statutory Instruments, the registry of court cases in Uganda and COVID-19 situation reports. Importantly, the COVID-19 Presidential pronouncements and directives on NPIs were based on sound scientific evidence. Shortcomings of this study included limited consultation with a broader scope of stakeholders due to the unique emergency response circumstances caused by the COVID-19 pandemic. However, this was overcome by Presidential speeches with directives informed by the COVID-19 National Task Force at the Office of the Prime minister, the sector-specific COVID-19 task force at the Ministry of Health, the Scientific Advisory Committee, and other lobbyists such as school owners and operators. Although this study did not document the impact of the COVID-19 Rules on NPI compliance, we found it important to describe in detail the process of enacting Rules as a starting point. Prospective impact evaluations are recommended. Also, the study did not investigate the perception and knowledge of the provisions in the Rules at the sub-national levels.

Implications for legal, public health practice and policy

Clearly, the findings of this study suggest several practice and policy considerations. Certainly, the Legal fraternity has a role to play in the control of pandemics. However, the available Legal expertise in Uganda, for example the Health Cluster of the Uganda Law Society, was limited to medical laws and not necessarily the wider public health realm. The COVID-19 pandemics underscores the need for a paradigm shift by Law Schools in Uganda to tailor modules on legal reforms of public health laws. Although public health interventions may be lifesaving, these should be enforced through Laws. The plethora of legal suits arising from the general provisions and specific Rules to control COVID-19 in Uganda reinforces this argument. The COVID-19 rules were time bound, with “sunset provisions”, and evolved with the epidemic curve. For example, the COVID-19 prohibition orders such as closure of the airport had an expiry period. Considerations of controlling deadly pandemics such as COVID-19 would balance the need to respect human rights. In other words, the Rules should not go beyond what is minimally necessary lest human rights were infringed upon. This suggests enforcement of COVID-19 NPI Rules would be accompanied by sensitization of the enforcement agencies such as the Uganda Police and Resident District Commissioners.

Implications for future research

This study delineates key information gaps for future investigation. Whether enactment of specific Rules to contain pandemics such as COVID-19 is relevant requires further study. For example, article 23 (1) (d) of the 1995 Constitution of Uganda provides for the withdrawal of personal liberties and hypothetically, if the Public Health Act (Cap 281) did not exist the Constitution would be sufficient. Further, the successful control of previous epidemics such as Ebola in Uganda was done without enacting specific Rules, which lends credence to this hypothesis. Additional studies would look into the impact of enacting COVID-19 specific Rules in relation to human rights and other unforeseen undesirable effects in Uganda. For example, religious freedoms were curtailed and delays in accessing primary health care by HIV/AIDS or pregnant women during enforcement of NPIs were reported. A crucial aspect of research would be when and how to integrate scientific evidence, public health interventions and legal provisions. For example, what NPIs go into law and what goes into SOPs would be informative and possibly efficient given the evolving scientific evidence base in previous unknown pandemics such as COVID-19. Finally, it would be informative to understand the interaction of local COVID-19 Rules and the WHO International Health Regulations 2005 for cross border health.

It was possible to successfully enact laws of Uganda specifically to control the spread of COVID-19 and possibly mitigate its impact. The perceived infringements on individual human rights would need to be balanced with the quest for community survival. As such, the study recommends public sensitization about legislative provisions and reforms to guide public health responses in future epidemics or pandemics. Finally, countries of similar settings could consider a platform to share “best practices” in enacting Rules for controlling disease outbreaks.

Ethics approval and consent to participate

Not applicable. This manuscript documents the Government of Uganda process of coming up with the Rules to control the COVID-19 pandemic and does not involve human participants.

Consent for publication

Not applicable. This manuscript documents the Government of Uganda process of coming up with the Rules to control the COVID-19 pandemic and does not involve human participants.

Availability of data and materials

This manuscript documents the Government of Uganda process of coming up with the Rules to control the COVID-19 pandemic. These Rules (Statutory Instruments), other accompanying laws are publicly available in the Uganda Gazette and the Uganda Legal Information Institute: https://ulii.org/ . Other data sources such as Presidential speeches are also available on the website of the Uganda Media Centre: https://www.mediacentre.go.ug/

Competing interests

The Authors declare no serious conflict of interest.

Funding

This work is supported under the National Action Plan for Health Security (NAPHS), awarded to the Infectious Diseases Institute, College of Health Sciences, Makerere University by Resolve To Save Lives, New. York City, USA (grant number RTLS-263).

Authors' contributions

Authors contributed to this work in various ways: conception (MIA, IN, JK, CA, SO, ML), data collection (MIA, IN, HB, MN, JB), drafting the COVID-19 Rules (MIA, BL, SM, JN, JRA), data analysis (MIA, IN, EAO, ML), writing the initial draft (MIA, EAO), and revising the subsequent drafts (MIA, IN, HB, SO, BL, SM, JN, JRA, MN, JB, EAO, ML). All authors participated in the various discussions to strengthen communication of Uganda’s COVID-19 Rules and accepted the final version of this manuscript.

Acknowledgements

The authors acknowledge the administrative support of Ms. Aisha Nakanwagi the NAPHS Project Administrator, and the of Offices of the Solicitor General and the Attorney General, Government of Uganda.

Zhan J, Li H, Yu H, Liu X, Zeng X, Peng D, et al. 2019 novel coronavirus (COVID-19) pneumonia: CT manifestations and pattern of evolution in 110 patients in Jiangxi, China. Eur Radiol. 2020.
Van Hout MC, Wells JSG. The right to health, public health and COVID-19: a discourse on the importance of the enforcement of humanitarian and human rights law in conflict settings for the future management of zoonotic pandemic diseases. Public Health. 2021;192:3–7.
Jee Y. WHO International Health Regulations Emergency Committee for the COVID-19 outbreak. Epidemiol Health. 2020;42:e2020013.
Wong MC, Huang J, Wong SH, Yuen-Chun Teoh J. The potential effectiveness of the WHO International Health Regulations capacity requirements on control of the COVID-19 pandemic: a cross-sectional study of 114 countries. J R Soc Med. 2021;114(3):121–31.
Tremblay-Huet S, McMorrow T, Wiebe E, Kelly M, Hennawy M, Sum B. The impact of the COVID-19 pandemic on medical assistance in dying in Canada and the relationship of public health laws to private understandings of the legal order. J Law Biosci. 2020;7(1):lsaa087.
Dowling MK, Terry AT, Kirilichin NL, Lee JS, Blanchard JC. United States Congressional COVID-19 Legislation: Recent Laws and Future Topics. West J Emerg Med. 2020;21(5):1037–41.
Mello MM, Parmet WE. Public Health Law after Covid-19. N Engl J Med. 2021;385(13):1153–5.
Farrell AM, Hann P. Mental health and capacity laws in Northern Ireland and the COVID-19 pandemic: Examining powers, procedures and protections under emergency legislation. Int J Law Psychiatry. 2020;71:101602.
Petersen E, McCloskey B, Hui DS, Kock R, Ntoumi F, Memish ZA, et al. COVID-19 travel restrictions and the International Health Regulations - Call for an open debate on easing of travel restrictions. Int J Infect Dis. 2020;94:88–90.
Burris S, de Guia S, Gable L, Levin D, Parmet WE, Terry NP. The Legal Response to COVID-19: Legal Pathways to a More Effective and Equitable Response, Journal of Public Health Management and Practice. 2021;27:S72-S9.
Republic of Uganda Ministry of Health. National Technical Guidelines for Integrated Disease Surveillance and Response. 2011.
Uganda Legal Information Institute. Interpretation Act Chap. 3. 1976.
Republic of Uganda. Constitution of the Republic of Uganda, 1995. 2005:195.
Republic of Uganda. Judicature Act Chap. 13. Uganda Legal Information Institute. 2000.
Government of Uganda. Address by H.E. Yoweri Kaguta Museveni President of the Republic of Uganda to the Nation Updates on Matters Regarding Corona Virus (COVID-19) and Lockdown Relaxation 22nd June, 2020 Nakasero. 2020.
Republic of Uganda. Public Health (Notification of COVID-19) Order Statutory Instrument No. 45 of 2020. Uganda Gazette. 2020;Volume CXIII(Statutory Instruments, Supplement No.9):1.
Republic of Uganda. Public Health (Control of COVID-19) Rules, 2020. Uganda Gazette. 2020;CXIII(Statutory Instruments, Supplement No. 11).
Republic of Uganda. Public Health (Prevention of COVID-19) (Requirements and Conditions of Entry into Uganda) Order. Uganda Gazette 2020;Vol. CXIII(Statutory Instrument, Supplement No. 17).
Uganda Peoples Defence Forces Act, (2005).
Government of Uganda. Public Finance Management Act, 2015. 2015.
Government of Uganda. The National Policy for Disaster Preparedness And Management. 2010.
Republic of Uganda High Court Civil Division. Turyamusiima Geofrey Versus Attorney General & Dr. Jane Ruth Aceng. 2020.
Katana E, Amodan, B. O., Bulage, L., Ario, A. R., Fodjo, J. N. S., Colebunder, R., and Wanyenze, R. K. Violence and discrimination among Ugandan residents during the COVID-19 lockdown.. BMC Public Health. 2021.
Wamala JF, Okot C, Makumbi I, Natseri N, Kisakye A, Nanyunja M, et al. Assessment of core capacities for the International Health Regulations (IHR[2005])--Uganda, 2009. BMC Public Health. 2010;10 Suppl 1:S9.
Mbonye AK, Sekamatte M. Disease outbreaks and reporting in Uganda. Lancet. 2018;392(10162):2347–8.
Bwire G, Munier A, Ouedraogo I, Heyerdahl L, Komakech H, Kagirita A, et al. Epidemiology of cholera outbreaks and socio-economic characteristics of the communities in the fishing villages of Uganda: 2011–2015. PLoS Negl Trop Dis. 2017;11(3):e0005407.
Kruger P, Moyo K, Mudau P, Pieterse M, Spies A. South Africa: Legal Response to Covid-19. In: King J, Ferraz O, Achiume T, Bogg A, Byrom N, Costello C, et al., editors. The Oxford Compendium of National Legal Responses to Covid-19. Oxford: Oxford University Press; 2021.
The Public Health (Covid-19 Restriction Of Movement Of Persons And Related Measures) (Kwale County) Order, 2020, Legal Notice No. 54 (2020).
Emergency Powers (COVID-19) Regulations, 2020, Statutory Instrument 61 OF 2020 (2020).
Li H, Hu M, Liu S. The need to improve the laws and regulations relevant to the outbreak of COVID-19: What might be learned from China? J Glob Health. 2020;10(1):010328.
COVID-19 Public Health Response Act 2020, Number 12 (2020).
UK Coronavirus Disease Act, Chap. 7, (2020).
Goldstein ND, Suder JS. Application of state law in the public health emergency response to COVID-19: an example from Delaware in the United States. J Public Health Policy. 2020.
Public Legal Information on Kenya's Response to COVID-19, (2020).
Republic of Trinidad and Tobago. Public Health [2019 Novel Coronavirus (2019-nCoV)] (No. 21) Regulations, 2020 Legal Supplement Part B 2020;Vol. 59(No. 110).
Disaster Management Act - Regulations and Guidelines on Coronavirus COVID-19, (2020).
Griffith R. Using public health law to contain the spread of COVID-19. British Journal of Nursing. 2020;29(5).
Care UKDoHS. Ninth two-monthly report on the Coronavirus Act 2020. United Kindgom; 2021 September 2021.
Barugahare J, Nakwagala, F. N., Sabakaki, E. M., Ochieng, J., and Sewankambo, N. K. Ethical and Human rights considerations in public health in low and middle-income countries: an assessment using the case of Uganda's responses to COVID-19 pandemic. BMC Medical Ethics. 2020.
Sjodin H, Wilder-Smith, A., Osman, S., Farooq, Z., and Rocklov, J. Only strict quarantine measures can curb the coronavirus disease (COVID-19) outbreak in Italy, 2020. Eurosurveillance. 2020;25(13).
Rickard C. Kenya's COVID-19 restrictions invalid, unlawful- Law Society. African Legal Information Institute. 2020.
Gonesa T, Shivamba, A., and Meerkotter, A. A legal overview of the impact of COVID-19 on justice and rights in Southern Africa. Southern Africa Litigation Centre. 2020.
R (Dolan) v Secretary of State for Health and Social Care and another, (2020).
Mello MM, and Parmet, W. E. Public health law after Covid-19. The New England Journal of Medicine. 2021;385:1153–5.
Goldstein ND, Suder JS. Application of state law in the public health emergency response to COVID-19: an example from Delaware in the United States. J Public Health Policy. 2021;42(1):167–75.
Haffajee RL, Mello MM. Thinking Globally, Acting Locally — The U.S. Response to Covid-19. New England Journal of Medicine. 2020;382(22):e75.

Table 1

List of the Rules developed and used to control COVID-19 in Uganda, 2020–2021
Sections of Public Health Act under which Rules and Orders are made (n = 4)	Title of the Rules and Orders (n = 22)	Notes
Minister’s power to notify – Sec. 10	1) Public Health (Notification of COVID-19) Order, No. 45 of 2020	The Order declared COVID-19 a notifiable disease.
Control of COVID-19 – Sec. 11 and 27	1) Public Health (Control of COVID-19) Rules, No. 52 of 2020 2) Public Health (Control of COVID-19) (No.2), Rules, No. 55 of 2020 3) Public Health (Control of COVID-19) (Amendment) Rules, No. 57 of 2020 4) Public Health (Control of COVID-19) (No. 2) (Amendment) Rules, No. 58 of 2020 5) Public Health (Control of COVID-19) (Amendment) (No. 2) Rules, No. 63 of 2020 6) Public Health (Control of COVID-19) (No. 2) (Amendment No. 2) Rules, No. 64 of 2020 7) Public Health (Control of COVID-19) (Amendment No. 4) Rules, No. 79 of 2020 8) Public Health (Control of COVID − 19) (No. 2) (Amendment No. 4) Rules, No. 80 of 2020 9) Public Health (Control of COVID-19) Rules, No. 83 of 2020 10) Public Health (Control of COVID-19) (Amendment) Rules, No. 94 of 2020 11) Public Health (Control of COVID-19) (Amendment No. 2) Rules, No. 112 of 2020 12) Public Health (Control of COVID-19) Rules, 2021, No. 38 of 2021 13) Public Health (Control of COVID-1919) (Amendment No.1) Rules, No. 59 of 2021	These Rules were made after the declaration of COVID-19 a notifiable disease. These were Rules governing the Non-Pharmaceutical interventions (NPIs) i.e. community quarantine including closure of congregate settings such as schools, places of worship, markets, shopping malls, arcades, bars and cinemas. Additionally, marriage ceremonies, vigils, funerals were restricted, and the sports events or group exercising were specifically prohibited. These Rules provided for exemptions for “essential services and workers”, for example medics, legal and insurance. The amendment of the Rules was based on levels of the outbreaks, for example, re-opening of schools and closing them.
Powers to enforce precautions at borders – sec. 36	1) Public Health (Prevention of COVID-19) (Requirements and Conditions of Entry into Uganda) Order, No. 46 of 2020 2) Public Health (Requirements and Conditions of Entry into Uganda) (Amendment) Order, No. 37 of 2021	These Order guided testing, medical examination, quarantine and other infection prevention and control measures at border points: land, water and airports.
Prohibition of entry into Uganda – sec. 36	1) Public Health (Prohibition of Entry into Uganda) Order, No. 53 of 2020 2) Public Health (Prohibition of Entry into Uganda) (Amendment) Order, No. 56 of 2020 3) Public Health (Prohibition of Entry into Uganda) (Amendment No. 2) Order, No. 65 of 2020 4) Public Health (Prohibition of Entry into Uganda) (Amendment No. 4) Order, No. 81 of 2020 5) Public Health (Prohibition of Entry into Uganda) Order, No. 84 of 2020 6) Public Health (Prohibition of Entry into Uganda) (Revocation) Order, No. 113 of 2020	These Orders generally closed Uganda’s borders, restricted the number of persons in cargo vessels, vehicles or aircrafts, restricted entry of persons infected with COVID-19 and administered their isolation/quarantine, treatment and care.

No competing interests reported.

Download PDF

Version 1

posted

You are reading this older preprint version

Read the latest preprint version →

COVID-19 and the Law in Uganda: Development and Application of the Public Health Act to Control the Pandemic, 2020-2021

Archived Versions:

Version 1

Abstract

Figures

Introduction

Methodology

Results

Discussion

Conclusions

Declarations

References

Table 1

Additional Declarations

Archived Versions:

Version 1