Ebola outbreak in the DRC: four reasons it will be hard to contain

“By the second week of the latest Ebola outbreak in the Democratic Republic of Congo it was already clear that containing the spread of the haemorrhagic disease was proving to be difficult. On 17 May 2026, the World Health Organization declared the outbreak a public health emergency of international concern. This is its highest level of global health alert. It is mostly reserved for an extraordinary disease outbreak or event that is a public health risk to many countries through international spread and hence requires global coordinated efforts. According to the WHO, as of 19 May 2026 the DRC had recorded more than 500 cases and 130 deaths, while its neighbour (Uganda) had recorded two cases and one death. These statistics are huge considering that the current outbreak was only declared on 15 May. The largest Ebola outbreak was in west Africa from December 2013 to March 2016. It caused 28,652 infections resulting in 11,325 deaths in 10 countries; 99% of the fatalities were in Guinea, Sierra Leone and Liberia. Infectious disease outbreaks are nothing new for the DRC, a central African country. Last year, while other parts of the world were shaking off the global mpox outbreak , the DRC was still struggling with it. But the current Ebola outbreak in the DRC has potential to become huge and of long duration. I am an infectious disease epidemiologist with experience of dealing with the Ebola outbreak in 2013-2016 in Sierra Leone. In my view there are four reasons while this outbreak will be hard to contain: late detection and insecurity misdiagnosis cultural factors shortage of global health funds. Read more: Health authorities are racing to contain Ebola in the DRC and Uganda. Here’s what’s making it so challenging Late detection One of the challenges is the time between a person being infected and being diagnosed (identifying the disease in a laboratory). This detection lag is a major problem because to control the spread of the disease, infected individuals need to be isolated. Ebola is highly contagious. Late detection was responsible for the early deaths and increased number of Ebola cases in Sierra Leone during the 2013-2016 outbreak. Early cases went unnoticed there because Ebola was new in the country. Clinicians and laboratory scientists were totally unfamiliar with it. The DRC is familiar with Ebola outbreaks and has witnessed more than any other country. But in the DRC, late detection is fuelling the rapid spread of the disease and is primarily due to insecurity in the region. The time it takes to identify an infectious pathogen in the laboratory depends on how long it takes for the pathogen to replicate to detectable level, the type of laboratory tests used, and (for some diseases) the development of antibodies. Ideally, for Ebola virus it varies between one and 32 days. The first confirmed case was a resident of Goma, a town which lies on the border with Rwanda and is highly unstable. Fighting between DRC government forces and rebels (believed to be backed by Rwanda) has been going on around Goma for a long time. Read more: Goma is threatened by conflict and a volcano: we’ve created a handbook to help hotspots like these The instability and volatility of the epicentre of the outbreak is having a major impact. Under those conditions, an infectious disease thrives and outbreaks mostly go unnoticed. The number of Ebola cases and deaths that have been registered in the current Ebola outbreak in the DRC is difficult to place within the susceptible-infected-recovered (SIR) model , a tool used in epidemiology. Ebola’s R0 ( basic reproduction number , a measure of disease transmission) ranges between 1.5 and 2.5, which means within a susceptible Goma population, a single infected person can spread the virus to an average of 1.5-2.5 Goma residents. However, the current Ebola incidence and deaths in the DRC exceed the expected number of secondary infections based on Ebola’s basic reproduction number. As of 21 May there were over 136 suspected deaths , 35 confirmed cases, and more than 600 suspected cases caused by the Bundibugyo strain in the ongoing outbreak in the DRC. Misdiagnosis The delay in diagnosis may also have been due to subtle early Ebola symptoms that can be misdiagnosed. Both malaria and typhoid have identical fever symptoms. During the early days of the Ebola outbreak in Sierra Leone, many nurses working at the Kenema Government Hospital and the Lassa Fever Hospital lost their lives because they misdiagnosed the disease as Lassa fever. Ebola and Lassa fever belong to the same class of viral haemorrhagic fever diseases since patients present with similar symptoms and pathophysiologies (what the disease does to the body). The other challenge with diagnosis in this outbreak is that it is a different virus to the one treated in the most recent Ebola outbreaks. Bundibugyo virus was first identified in Uganda in 2007. Unlike Zaire Ebola virus disease, which was discovered decades ago, the relative newness of Bundibugyo Ebola virus disease means it’s less researched, especially in terms of vaccine and medicine development. Cultural factors Other factors affecting the spread are cultural practices such as ritual burials. Ritual burials are common in many African countries, like Sierra Leone and the DRC. These are ceremonies born out of the belief that death is a sacred passage to another world or ancestral realm. Mostly it starts with communal grieving and wake keeping, followed by the ceremonial preparation of the body. In Sierra Leone a ritual burial of a high priest who died of Ebola in the southern town of Moyamba during the 2013-2016 Ebola outbreaks led to the death of scores of people who took part in ceremonial preparation of his body. It is not surprising to learn of relatives setting Ebola hospital tents on fire simply because they were prevented from handling the corpse of their loved one. Read more: Ebola survivors struggle to return to normal lives: what I found out in Sierra Leone and Liberia Shortage of global health funds The cuts in global health funds and the ending of many projects through the dissolution of the United States Agency for International Development (USAID) is greatly affecting the operations and effectiveness of public health activities around the world. Most global health security projects aimed to prepare for and mitigate any future disease outbreak. Sierra Leone and other countries affected by the 2014-2016 Ebola outbreaks benefited immensely from international donor (including USAID) support during that outbreak. Unfortunately, the DRC will have less international support to help fight this outbreak. The country has long experience in tackling disease outbreaks (especially Ebola) but the lack of experts and logistics on site implies an extended delay in managing this situation. The DRC has the people and the necessary labs and facilities. The major challenge with the current outbreak is that it started in an insecure environment where access to testing facilities are scarce, hence the late detection. Additionally, the country is about the size of western Europe (including France, Germany, Spain, the UK and Italy). This vast size, coupled with insecurity, will make it difficult to channel logistics across the affected regions. What’s needed Tackling the current Ebola outbreak in the DRC requires a rapid, multi-tiered response. It should focus on rapid case detection, multinational support, swift collaborative surveillance and community engagement. Over the past years the DRC has served as a scientific base for major international research institutions that work on infectious diseases and medical microbiology. In the absence of a vaccine or medication, the health authorities should embark on community engagement to raise awareness and sensitisation. They must also enforce public health laws, especially those targeting cultures that promote unsafe burials and elevate the risk of Ebola infection. This is to prevent human transmission as many people might still be out there undetected. Jia B. Kangbai does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

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