DRC’s Ebola outbreak has the potential to become a global pandemic. How to make sure it doesn’t

Given its speed, scale and scope, the Bundibugyo Ebola virus disease that broke out in the Democratic Republic of Congo in mid-2026 could become a global epidemic. I am an infectious disease epidemiologist with experience in managing the 2014-2016 Ebola outbreak in my country, Sierra Leone. Drawing lessons from Sierra Leone and having watched the mid-2026 outbreak in the DRC, I conclude that it risks become a global epidemic. There are a number of reasons for this. Preventing a fast-spreading outbreak that has already taken over a large geographical region is difficult. The speed of the outbreak makes it challenging to even quantify the true scale of its spread. It’s hard to measure its true metrics, like incidence (the number of cases detected) and case fatality rates (the proportion or percentage deaths among the detected cases) on a daily basis. It took on average four months for the cumulative 2013-2016 west Africa Ebola outbreak cases in Guinea, Liberia and Sierra Leone to reach 1,000 after official declaration. In the DRC outbreak it took less than two months to reach that same number. These statistics are post-outbreak declaration statistics. This outbreak started a long time before it was officially detected, which implies transmissions and deaths have occurred that are not being captured. Only those Ebola cases that presented after its official declaration have been documented. This implies that frontline health workers have to contend with huge backlogs of Ebola cases for treatment, surveillance and contact tracing. Given its current scale and speed, the following actions are needed: inject adequate and sustained multi-month funding to pay for frontline workers, lab consumables, personal protective equipment and infection prevention and control supplies ensure rigorous anti-infection measures are adhered to in health facilities and border posts actively involve community members in the response by working with trusted local leaders, religious leaders, youth groups and community health workers screen borders design a safer patient-care pathway – a triage, isolation, testing and treatment system. Possible reasons for rapid spread Ebola is generally a highly contagious disease with a high transmission rate. A primary Ebola case can transmit the infection to between 1.5 and 2.5 other people. But the rapid spread of Bundibugyo virus disease falls outside this expected epidemiological unit. A number of interlinking factors are driving this rapid spread. These include: the emergence of super-spreaders; a lack of data; a lack of therapeutics and vaccines; the slow and non-adoption of public health interventions; challenges to full community engagement and trust; and insecurity due to ongoing armed conflict. The role of super-spreaders The role of disease super-spreaders in outbreaks is not new. In one study conducted during the 2014-2016 west Africa Ebola outbreak, super-spreaders were reported to have been responsible for more than 60% of sustained onward transmission. Super-spreaders are infected people who disproportionately transmit pathogens to susceptible people during an outbreak. This can be due to the way disease affects the body, and to environmental, behavioural, social and demographic factors. Disease super-spreading is more common during the early stage of an outbreak. It is more pronounced for a relatively new disease or a rare strain of a pathogen. In these situations, infected people serve as super-spreaders mostly because they don’t know how the infection is spread or prevented. Read more: Ebola outbreak in the DRC: four reasons it will be hard to contain The rarity of the Bundibugyo strain makes it a likely candidate for super-spreading. The lack of appropriate diagnostic kits was largely responsible for the late diagnosis in the early period of the outbreak. This has led to its continued spread. Because of the geographical size and velocity of this outbreak, the challenge caused by insufficient diagnostic kits added another layer to managing it. When someone gets sick, the expected thing to do is to diagnose and treat. This works well when the infected person is familiar with the signs and symptoms of the disease. Unfamiliarity with the symptoms can lead to delays in seeking treatment and hence sustained transmission. Age has also played a role in super-spreading – in this outbreak and in previous ones. The age of an infected person (especially infected children below 15 and adults above 45 years) was reported to have been primarily responsible for super-spreading in the 2014-2016 west Africa outbreaks. In the ongoing DRC outbreak, the age group of 18-49 years accounts for the bulk of the infection, while a quarter of deaths are children below 15 years. Children are unfamiliar with the signs and symptoms of Ebola and seek treatment late. Because of this they will spread the disease to their caregivers. The age group 18-49 years will engage in high-risk activities, including unprotected sex, that will increase the transmission rate of the disease. Bundibugyo Ebola virus is transmitted through contact with the blood or bodily fluids of an infected person or contaminated surfaces or material. Read more: Ebola survivors can pass on the virus: we’re trying to understand what role sex plays Super-spreading is also affected by how the disease presents itself. In the DRC, because of the rarity of Bundibugyo virus, little is known about its signs and symptoms, which makes it challenging during early physical diagnosis. Ebola Zaire, the most common strain of the virus, has an early acute wet-phase characterised by vomiting, diarrhoea, coughing and haemorrhaging. But the early symptoms of a Bundibugyo infection are dry: the person may experience fever, fatigue, muscle pain, headache, and sore throat. These symptoms could easily be misclassified as other tropical infections. This mild nature gives false hope to patients and serves as an “incentive” to delay seeking treatment. Adding to this layer of complexity is the prevailing insecurity climate in the DRC, which in turn delays people being able to source treatment. The eastern DRC has been plagued by violent conflict for decades, and this is where the outbreak is spreading. Data gaps, resistance and insecurity The DRC outbreak has shown what outbreak preparedness can achieve and what still needs to be delivered. A big challenge is data. When an outbreak has been going on silently for weeks, undetected, the data that emerges after it’s declared an emergency is mostly speculative. With less than 20% of all Bundibugyo incidences in some health zones traced to recognised contacts, there is a tendency for the disease to spread to unaffected regions. This makes controlling an outbreak difficult. Adding to that problem are attacks on health and aid workers by the families of affected patients. August 2026 saw the highest number. The attacks mostly stem from deep mistrust of authorities, as well as cultures and traditions clashing with medical protocols. Other factors contributing to the spread include: the sheer size of the DRC – almost the size of western Europe in land mass. By September 2026 Bundibugyo had affected an area the size of France. porous borders, making it impossible to trace people ongoing insecurity: the government in Kinshasa finds it difficult to govern and provide basic services across the entire country treatment void – the lack of registered therapeutics and vaccines to treat and prevent the spread of Bundibugyo is another reason it risks becoming a global epidemic. Read more: The hunt for a new Ebola vaccine: two scientists explain the challenges The failure to develop a Bundibugyo vaccine has been a catastrophic biomedical and governance oversight. It should not have happened, given that localised Bundibugyo outbreaks had occurred several times in the DRC. Potential diagnostic kits, therapeutics and vaccine candidates have been put into trial stage. But outbreak preparedness should have started much earlier. Preventing a global Bundibugyo epidemic Preventing a fast-spreading outbreak that has already taken over a large geographical region will be difficult. It requires nuanced strategy. One major lesson I learned from the 2014-2016 west Africa Ebola outbreaks was that prevention strategies should always be designed to accommodate setbacks. Planners need to be able to address, persevere with and respond to those emerging challenges as they go along. The deployment of Ervebo Ebola Zaire vaccine in the DRC is welcomed. But stopping an epidemic relies on strong public health interventions, including vaccination, in the presence of total community engagement and trust. At least the current Ervebo Ebola Zaire vaccine trial will lead to the collection of evidence, which is better than starting all over again in future. The input of global health actors at the international and national levels is also needed. The dissolution of USAID and cuts in public health funding are bound to create more global health problems. Providing ad hoc funding during a public health crisis cannot fill the gaps in outbreak preparedness and prevention. The cut in funding has placed tremendous pressure on surveillance, which is very important during such a high-paced outbreak. Health zones where the Bundibugyo prevalence, mortality and transmission rates are high should be areas of paramount concern for surveillance. In a country as vast as the DRC, surveillance requires huge logistics and human resources. The most urgent action needed to prevent a global epidemic is to double down on real-time testing, which in turn depends on robust disease surveillance. Funding is key. Lack of funds can affect the arrival of international experts, logistics and humanitarian aid to the remaining unaffected areas outside eastern DRC. Over US$500 million is reported to have already moved into the DRC since the outbreak was declared. This means there shouldn’t be any reason for frontline workers to go unpaid. The strike actions by frontline workers suggest that public health activities to tackle an outbreak of such scale and pace should work in tandem with financial accountability and thorough administrative policies. 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.