After Covid-19, Before Ebola: Why Are We Still Without the Small Laws?

Ghanafuor, there is a particular comfort in watching an outbreak on a screen. It is far away, it belongs to someone else's ministry, and the distance flatters us into thinking that what separates us from it is geography.

It is not geography.
If Bundibugyo virus reaches Ghana, it will find a country with an awake health service and a sleeping legislature, and the two will not be equally matched. It will find that we never passed the small laws, the ones about spittle and about the dead, and that the water does not run.

And here is what should shame us. We had the rehearsal. Between 2020 and 2022 this country lived through two years of epidemic emergency. We were taught, all of us, to wash our hands and to keep our distance. We built the habit, or half of it, and then the emergency ended and we let everything lapse. The laws we should have passed while the fear was upon us, we never passed. Now the fear has gone to another continent and the laws are still unwritten.

Begin with the virus, because it deserves to be described properly.

The outbreak in the Democratic Republic of the Congo was declared on 15 May 2026. This is not the Zaire species, against which a licensed vaccine exists and which the world has learned to stop. This is Bundibugyo, identified in Uganda in 2007, and nineteen years later there is still no licensed vaccine and no approved treatment for it.

The World Health Organization's situation report of 23 October put the DRC at 9,704 confirmed cases and 4,687 confirmed deaths, a case fatality ratio of 48.3 per cent, across 66 health zones in eight provinces. The American CDC's count for the same date was 9,847 cases and 4,761 deaths. Kenya has nine cases, including two deaths, all traced to one man who travelled from the DRC through Uganda. Nigeria confirmed an imported case in a woman who had travelled from Uganda. Uganda's own outbreak was declared over on 27 August after 42 days of silence.

Read the fatality ratio again. Of every two people confirmed infected, one dies. There is no vaccine. There is no drug. The only tools are water, soap, gloves, isolation, and the willingness of a community to tell the truth about its dead.

Which brings me to the sentence in the WHO's 23 October update that should be read aloud in every district assembly in this country. Of the 482 deaths reported since the previous update, 307 occurred in communities and 175 in treatment centres.

Think about what that means. Nearly two out of every three of those deaths happened outside the health system. Which means those bodies were handled outside the health system, washed by the people who loved them, laid out by the people who loved them, and buried by the people who loved them.

That is not a failure of medicine. It is a failure of law, and of the courage to make law.

The evidence is not soft. In Kissidougou, in Guinea, in December 2014, a single traditional funeral ceremony was linked to 85 confirmed Ebola cases. In Moyamba, in Sierra Leone, one funeral of a prominent man produced a sudden jump in cases in a district that had almost none. The WHO built its safe and dignified burial protocol in November 2014 precisely because the corpse, at the moment when viral load is highest, is the most dangerous object in the epidemic, and because the washing, the touching and the kissing of the dead are acts of love.

You cannot ask people to stop loving their dead. You can only give them a way to do it that does not kill them.

Now here is what is strange about Ghana. We already have the power. Section 16 of the Public Health Act, 2012, Act 851, allows the Minister, by legislative instrument, to prescribe the mode of burial or disposal of the body of a person who dies from a communicable disease, along with a long list of other measures for the control of infection.

The power exists. What does not exist is the instrument, drawn in peacetime, sitting on a shelf, ready to be triggered by a declaration. And what does not exist is a funded burial corps in each region: trained, equipped, paid, and able to reach a village within hours with dignity rather than with a bulldozer.

So let me say what I would do, and let me be careful, because this is where good intentions go to court.

I would not criminalise every funeral in Ghana, and I would not order that every corpse in the country be burned within 72 hours regardless of faith. That law would fail, and it would deserve to. Article 21(1)(c) of the Constitution protects the freedom to practise any religion, and no government is going to win an argument with the churches and the mosques by arriving at a bereaved household with a court order and a furnace. We would spend a decade in litigation and lose the habit of obedience along the way.

What I would do is make the burial of the dead a declared-outbreak matter, not a permanent war on grief. On a declaration, and only on a declaration, three things follow. Every death in the affected districts is notified, not only the suspicious ones. No wake is held without a permit from the district director of health. And every suspected case is buried or cremated within 48 hours, by a team trained and paid to do it, with the family present as far as safety allows.

Note what that does not touch. Islamic practice already requires burial promptly, within a day. Our own tradition does not. Ours is the mortuary, the long fundraising, the body lying in state, and the grand final funeral rites held months after the death. I have seen enough people buried in my 74 years to know how much of that is love and how much of it is status, and I will not pretend the two can be separated cleanly.

But the mortuary is where the epidemic will live if it comes. A body kept for six weeks in a cold room, then washed and displayed and wept over by five hundred people, is a transmission event waiting for a cause of death.

And that is a question not of doctrine but of industry: who owns the mortuaries, who inspects them, who records what killed the person in the drawer. If we cannot answer that today, in peacetime, with no outbreak on our soil, then we have not prepared. We have only hoped.

Now the spittle, and here I must be honest with you, because a lie in a good cause discredits the cause.

Spitting in public will not give anyone Ebola. The virus spreads through direct contact with the blood and body fluids of a person who is already sick, a narrow route, and saliva on its own is not the highway. Anyone who tells you otherwise is trying to frighten you, and you should not let them.

But that was never the whole argument.
Spitting in public spreads tuberculosis. Ghana's burden of TB is put at 280 cases per 100,000 people, and a 2025 study of private-provider case finding found that only 29 to 34 per cent of estimated incident cases over the preceding five years were detected and notified at all. We are missing two thirds of our tuberculosis, in a country where a man hawking in a trotro will spit on the floor between the seats and nobody will say a word.

The cities of Europe and North America understood this a hundred and thirty years ago. They banned public spitting as a tuberculosis measure, put notices on railway platforms, fined offenders, and relaxed only when the disease receded. Singapore still fines up to a thousand Singapore dollars for it.

Ghana has no such law and no such norm. And here is why that matters for a virus that has not arrived: a state that cannot regulate a habit cannot regulate a ritual. The capacity to pass a small law and enforce it in a market is the same capacity you need to close a wake in a village at midnight. If we cannot do the first, do not tell me about the second.

And we have already shown which one we can do. In 2020 we reached for executive instruments, and they worked, more or less, for as long as they lasted. Then they expired, and we went back to spitting in the trotro. An emergency regulation is not a law. It is a loan of authority that has to be repaid.

Which brings me to the pipes, and to the part of this that no amount of legislation can fix, because it needs money and competence and time.

Ebola asks one thing of a household above all: a place at the entrance where hands are washed, with running water and soap, for everyone who comes in and goes out. It asks the same of a clinic, with chlorine added.

Look now at what we have built instead.
The Ghana Statistical Service's 2021 census found that sachet water is the main source of drinking water for 37.4 per cent of households, and for 51.5 per cent of urban households. Only 31.7 per cent of households nationally, and 33.6 per cent of urban households, use pipe-borne water as their main source. Some 1.4 million urban households have no water on their premises at all.

A February 2026 situational analysis drawing on PURC and Ghana Water Limited's own tariff submissions found that the utility produces about 945,275 cubic metres a day against urban demand of about 1.19 million, a daily shortfall of 244,725 cubic metres, some 21 per cent. It found that non-revenue water stands at about 52 per cent, so that barely half of the treated water leaving the works is ever billed. It found an on-lent debt burden of GH¢14.63 billion, with GH¢38.94 million spent every month servicing debt, nearly 23 per cent of monthly income.

Set that beside the January tariff adjustment, which raised water by about 15.9 per cent. We are being asked to pay more for water that has a coin-flip chance of arriving.

Now put the two facts together. A country where half the treated water is lost before it reaches a tap, and where half of urban households depend on a sachet, is a country that cannot execute the single instruction that stops Ebola in a home. Wash your hands. With what? In what? Into what?

The instruction presupposes a tap. Half of our households do not have one.

This is the part of preparedness that no minister can announce at a press conference with a straight face, because it is a sixty-year failure of investment, maintenance, metering, billing and theft, and it cannot be fixed during an outbreak. It can only be fixed in the boring years before one.

So, Ghanafuor, what do we actually do? Five things, and not one of them needs a summit.

First, draft the burial instrument now, under section 16 of Act 851, and put it on the shelf. Not a permanent law against funerals. A trigger, written in peacetime, that a Minister can activate on the day of a declaration, so that nobody is drafting regulations while a village is washing a body.

Second, fund and train a safe and dignified burial team in every region, with vehicles, PPE, a stipend that arrives on time, and a protocol agreed in advance with the Christian Council, the Catholic Bishops' Conference, the Chief Imam and the House of Chiefs. Get their signatures before we need them. The WHO protocol works because it was built with faith leaders, not imposed on them.

Third, make public spitting an offence with a real fine, and enforce it in trotros, markets and lorry stations for the sake of tuberculosis. It will be unpopular for a month and normal within a year, the way the seatbelt was.

Fourth, publish the baseline. Every district should report all-cause deaths weekly, not only notifiable diseases. Ebola hides inside ordinary mortality. A country that cannot see its own background deaths cannot see an outbreak until it is a ward full of them.

Fifth, treat water as clinical infrastructure. Name every district hospital and health centre without a reliable on-site supply, publish the list, and fix that list before anything else, because a treatment unit without water is not a treatment unit, it is a room with beds in it. The WHO and UNICEF reported in August 2026 that only 85 per cent of health facilities worldwide have a basic water service. Our own figure is sitting in a ministry file somewhere. It belongs on a wall.

There is a version of this that ends well, and it is unglamorous. It is a district assembly that has the burial protocol in a drawer. It is a nurse who does not have to choose between isolating a feverish man and finding water to wash her own hands. It is a law about spitting that nobody remembers passing, because by the time it mattered it had become a habit.

The alternative is the version we have already rehearsed across this continent. A flurry while the outbreak is on the television. A budget that returns to what it was. A country that feels safe because the scanner at Kotoka beeps, when the scanner has never stopped anything in its life.

Ebola will not be stopped in the arrivals hall. It will be stopped by a law we pass now, a tap that runs in a village, and a burial that is safe and still honours the dead.

We need to get that quickly, oooo, Ghanafuor. Now. Not tomorrow. Yooooooooooo. A word to the wise…