Are we ignoring a brewing epidemic?

Ebola is a deadly disease. It can kill up to 90% of those infected. Its recent outbreak started in the Democratic Republic of Congo (DRC) in late May, and in just a few weeks it has already killed more than one thousand people. There have been multiple Ebola outbreaks in the past, including the 2014 outbreak which affected nearly 10 countries and killed more than 11,000 people. However, the WHO has called this the fastest?spreading Ebola outbreak ever, as in less than two months cases have surpassed 2,500. There are multiple warning signs, including the fact that 80% of cases have no known contacts prior to getting the disease, meaning widespread, undetected community transmission.

What makes this outbreak different from previous Ebola outbreaks is that this is the first major outbreak caused by the Bundibugyo virus (BDBV) type of orthoebolaviruses (viruses which cause Ebola disease). Previous outbreaks have been caused by other types of Ebola viruses. The 2014 outbreak was caused by the Zaire species, and now we have effective treatments and even a vaccine for that species of the virus. However, as BDBV has only been implicated in small outbreaks in the past, there is no treatment or vaccine available.

Ebola has, for the most part, been a disease of sub?Saharan Africa. However, a few imported cases have been diagnosed in Europe and the USA. From 2014–2019, more than three billion US dollars were invested in the region by international health and multilateral organisations to strengthen Ebola detection and outbreak response. Unfortunately, what we are seeing now is a lack of public health response infrastructure. If today, ten years after the last major outbreak, we are still seeing the same basic health challenges, it is alarming. Healthcare worker infections mean shortcomings in infection?control practices. If 80% of cases have no known links, it means contact tracing is absent. This is disappointing when you consider the amount invested in a small region. Unfortunately, there is no accountability in public health.

What are the chances of this outbreak spreading beyond Africa? In the past, we have seen Ebola spread to other countries, but sustained transmission outside Africa has been extremely rare. Will that remain true for this new type of virus? We are not sure. However, my biggest nightmare since 2014 has always been: what will we do if a few patients quietly get admitted to our hospitals? I have always feared that this could start local epidemics, as our health facilities lack infection?control practices. Every year healthcare workers are infected with Congo virus and some have died, but that happens every year. Similarly, reusing needles in many healthcare settings has resulted in major HIV outbreaks in children. So the threats are grave and serious.

The good thing is that this is not an airborne infection, unlike COVID?19. Airborne infections have a high potential to start pandemics, as controlling transmission is difficult. Ebola spreads through direct contact with body fluids. In many countries, its wider spread is due to burial practices which are deeply rooted in communities and involve extensive contact with the dead body. For that reason alone, we could contain it to a small geographic area with effective outbreak?control measures.

But containment requires accountability, and we need accountability for the billions of dollars that were expected to keep countries and the world better protected from this deadly disease. Every dead body means someone made the wrong decisions in the last decade to keep this population safe. Even today, daily case numbers and deaths are difficult to get. Global Health Security needs transparency and better coordination. Current Ebola may not turn into a new pandemic, but what if some new deadly airborne virus comes in our way! We were unprepared in 2019, and we are still unprepared in 2026. For global health leaders, it's time to ponder. We don't need talk, we need action led by those who know what they are doing. It's about our survival.