Ebola outbreak in democratic republic of Congo spirals out of control

The Ebola epidemic in the Democratic Republic of Congo (DRC) shows no signs of slowing down. This grim assessment was confirmed on August 5th by the Deputy Medical Director of Médecins Sans Frontières during an official visit by the World Health Organization’s Director-General to the eastern part of the country. More than two and a half months after the outbreak was declared on May 15th, this epidemic has become the second-largest ever recorded, with a spread rate unlike anything previously observed. According to the latest figures from the Congolese government and the World Health Organization, the death toll has now reached 1,850 out of approximately 4,000 confirmed cases, with a fatality rate exceeding 40%.

The Bundibugyo strain responsible for this outbreak has already claimed more lives in a comparable timeframe than all previous outbreaks of this variant combined, as reported by the Africa Centres for Disease Control and Prevention. During the last major epidemic in the DRC, which lasted from 2018 to 2020, it took over ten months to reach a similar death toll. “I cannot confidently say we are fully in control of this epidemic at present,” admitted Jean Kaseya, Director-General of the Africa CDC, in late July.

Violent unrest hampers case tracking and containment efforts

The eastern DRC, where the outbreak is concentrated, presents a uniquely challenging environment for medical coordination and case detection. The Ituri province, the epicenter of the epidemic, has been plagued by relentless terrorist attacks by the Allied Democratic Forces, an armed group originating from Uganda. Meanwhile, numerous militias operate across the region, vying for control over land, mineral resources, and local influence. The neighboring North Kivu province, also affected by the outbreak, remains partially beyond the control of the Kinshasa government. Large swathes of this territory have been under the control of the M23, a Rwandan-backed armed group, for over a year following intense clashes with the Congolese army.

Years of violence have displaced millions of people, many seeking refuge in Uganda, Burundi, or other parts of the DRC. This humanitarian and security crisis has left populations living in dire conditions, with poor sanitation and limited access to healthcare. Compounding the challenge, early surveillance and testing capabilities were severely inadequate due to insufficient funding, delaying the identification and confirmation of cases.

Contact tracing efforts have also fallen short of expectations. In Bunia, the epicenter of the outbreak, Médecins Sans Frontières reports that 90% of admitted patients were not part of any tracked contacts. Across Ituri province, only 59% of contacts have been traced. For every confirmed urban case, the Africa CDC estimates that approximately 40 contacts should be monitored, suggesting a need for around 134,400 individuals to be tracked. Yet, only 17,500 are currently being followed—just 13% of the required number. Roughly one-fifth of recorded cases receive no regular monitoring due to staff shortages or ongoing violence. Another alarming sign of the outbreak’s spread: 60% of deaths have occurred within communities rather than in healthcare facilities.

Experimental treatments and vaccines offer limited hope

Despite these challenges, progress is being made to curb the epidemic. This month, the first clinical trial for a vaccine against the Bundibugyo strain began at the University of Oxford. The initial volunteer has received the vaccine, with the trial aiming to enroll 50 adults to assess its safety. The Coalition for Epidemic Preparedness Innovations (CEPI) is also funding the development of another vaccine by Singapore’s Hilleman Laboratories, with plans to rapidly produce and test doses in the DRC.

In the absence of a vaccine for this highly virulent strain, the Africa CDC announced on August 6th that it would deploy large-scale vaccination campaigns using the Ebola Zaïre strain vaccine. While the Bundibugyo variant differs, preliminary data suggests that individuals vaccinated against the Zaïre strain experience only mild symptoms and do not succumb to the disease. According to reports, over 40 patients are also participating in a trial evaluating a combination of treatments.

Jean Kaseya has further announced plans to expand the use of remdesivir, an antiviral medication, across the DRC, citing its success in neighboring Uganda. “Uganda’s fatality rate stands at just 10%, primarily because authorities there administered remdesivir to all infected individuals and their contacts,” Kaseya explained. International health authorities warn that this outbreak could surpass the devastating 2014–2016 West Africa epidemic, the deadliest on record, which resulted in over 11,000 deaths.

International aid arrives too late to make an immediate impact

Delayed international support has further exacerbated the crisis. Early this year, the U.S. administration cut decades of health and medical aid provided by USAID to the DRC, severely weakening the country’s capacity to respond. On August 5th, the U.S. State Department finally announced a new allocation of $242 million, bringing the total direct U.S. aid for Ebola response to $512 million. This funding, though long overdue, will enable the World Health Organization and the CDC to implement their six-month Ebola response plan, estimated at $518 million. However, this amount remains far below previous U.S. contributions to humanitarian and health aid efforts. The U.S. remains the leading contributor to the Ebola response, surpassing the European Union by a significant margin.