The rapid spread of a rare Ebola strain through Central and East Africa is testing local public health authorities and raising concerns about the state of global health security.
The proliferation of a rare strain of Ebola known as the Bundibugyo virus in Central and East Africa now constitutes the third-largest Ebola outbreak on record. Having likely circulated undetected since around February, the disease continues to spread in the Democratic Republic of Congo (DRC), with additional cases in Uganda and France, more than a month after the World Health Organization (WHO) declared it a public health emergency of international concern.
There have been more than a thousand confirmed cases and hundreds of fatalities so far, with most cases concentrated in eastern DRC. While the global risk remains low, experts worry the outbreak could burgeon into a broader regional health crisis.
“We do not yet have a full picture of how widespread the outbreak is,” Stephanie Psaki, who served as the inaugural U.S. coordinator for global health security at the National Security Council during the Biden administration, told CFR. It is “probably on track to be [the] first or second largest before it’s contained,” she said.
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In addition to allocating $3.9 million from its Contingency Fund for Emergencies in May, the WHO and the Africa Centers for Disease Control and Prevention (Africa CDC) co-launched in early June a $518 million, six-month emergency response plan to contain the outbreak in the DRC and Uganda. However, declining humanitarian aid levels globally, the loss of the U.S. Agency for International Development (USAID), and the diminished international role of the U.S. CDC–which historically led international Ebola responses–have raised concerns about meeting that goal.
CFR unpacks what is driving the current Ebola outbreak, the scale of the crisis, and what it means for the state of global health infrastructure and preparedness.
What is Ebola?
Ebola is a rare, severe illness that attacks the immune system, causing extreme fluid loss and often death. People can contract the disease through contact with infected wild animals such as fruit bats, or by handling and preparing contaminated foods. Unlike more common viruses such as COVID-19 or the flu, Ebola is not transmissible before an infected person begins to exhibit symptoms–which can start appearing between two to twenty-one days after exposure–though the risk of transmission increases as the disease progresses.
The average fatality rate is approximately 50 percent, according to the WHO, though case fatality rates have previously ranged from 25 to 90 percent depending on the strain and availability of care.
Where has it spread?
The current bout of Ebola originated in eastern DRC and is the country’s seventeenth such outbreak since 1976. As of July 4, there have been 1,561 confirmed cases and 506 confirmed deaths in the DRC. In Uganda, 20 cases and 2 deaths have been reported as of June 29, according to the country’s ministry of health. However, experts warn that the exact number of cases in both countries is likely higher. One case was confirmed in France in June in a traveler returning from the affected region after volunteering in the response effort.
To complicate matters, misinformation about the virus has been rife. There are several reports of Congolese communities raising concerns that the disease is a hoax, or was brought in by Western aid workers aiming to make a profit in the region.
“Public trust in authorities is exceedingly low, and foreigners are often presumed to have exploitative agendas,” CFR expert Michelle Gavin told CFR. It is therefore not surprising that locals “are rarely willing to absorb public health messaging at face value, or that the environment is ripe for misinformation,” she added.
Ebola is just one issue among a slew of others the Congolese communities are currently facing, including deaths from violent conflict, and other infectious diseases such as malaria and measles. The chronic, debilitating nature of these challenges makes Ebola feel like less of a priority among them, locals have told health experts.
What’s driving the current Ebola outbreak?
A U.S. CDC analysis estimates the virus was transferred from an animal to a human in February, but the health ministries in the DRC and Uganda did not declare an outbreak until mid-May. The WHO said it was first alerted on May 5 of suspected Ebola cases in the DRC, but initial tests were negative since they were not designed to detect the rare Bundibugyo strain.
“I find it unfathomable that something would have spread for three months without [health authorities] identifying it with the systems that we had in place,” said Psaki. “That includes not just U.S. government staff, but the partners that were working around the world that were receiving support from the U.S. government and also multilateral institutions like [the] WHO.” Because containing Ebola depends on early detection, isolation, and tracing, the delay has increased the risk of the outbreak expanding further.
The Bundibugyo virus is a separate strain from common Zaire species, rendering existing vaccines ineffective against it.
The outbreak is happening against a backdrop of severe, ongoing instability in the region. Decades of conflict in the DRC has hampered authorities’ ability to address public health concerns. Nearly seven million people are internally displaced, five million of whom are in North Kivu, South Kivu, and Ituri provinces, the regions most affected by the outbreak.
The ongoing conflict creates “extraordinarily difficult conditions for infectious disease control,” said Gavin. She added that community displacement, armed group movements, and smuggling mean unreported border crossings occur regularly, making it difficult to track the spread of the virus.
As the outbreak spreads, Psaki told CFR that the primary challenge now is limiting internal and cross-border transmission to neighboring states–including Burundi, Rwanda, South Sudan, and Uganda–through border screenings and case detection. “Even in the best-case scenario, it will continue to spread for some time,” she said. “At this point the question is really how well prepared these countries are in terms of screening at their borders and identifying cases.”
Contact tracing is crucial to curbing the spread of Ebola. While health officials aim to trace at least 95 percent of contacts, experts say the actual figures vary widely and are believed to be well below that benchmark. The WHO reported only about 60 percent as of June 9.
What’s the risk of the outbreak going global?
At a media briefing on June 3, WHO Director-General Tedros Adhanom Ghebreyesus said the organization assessed the risk of Ebola to be “very high at the national level, high at the regional level, and low at the global level.” No Ebola outbreak has ever spread enough internationally to meet the threshold of a pandemic.
Despite the low global risk, a number of countries have implemented travel restrictions, including entry bans, flight suspensions, and quarantine requirements. Canada and the Bahamas, for example, are temporarily banning residents from the DRC, South Sudan, and Uganda. France, which confirmed its first Ebola case on June 24, has established a monitoring system for aid workers returning to the country from the DRC.
There are currently no suspected or confirmed cases within the United States. A U.S. citizen working in the DRC tested positive for Ebola on May 17 and was taken to Germany for treatment. Subsequent plans for U.S. citizens exposed to the virus to quarantine in Kenya have faced considerable backlash. The CDC has since announced entry restrictions on non-citizens and green card holders from affected countries and implemented enhanced screening for U.S. citizens returning home from those countries. The United States also paused visa services at its embassies in the DRC, South Sudan, and Uganda due to the outbreak.
“I do think there is just a reality that when outbreaks like this spiral out of control… something that you think is only relevant in other parts of the world eventually is going to become relevant [in the United States],” said Psaki, pointing to the 2014-16 West Africa Ebola epidemic, during which Ebola reached the United States.
Ebola has long been a fear for people in the United States, primarily due to public misconceptions about the disease. But those misconceptions do more harm than good, said Gavin. “Africans resent being stigmatized by outbreaks like this one,” she told CFR. “When countries like the United States propose policies to keep infected Americans on the continent for treatment… it sends a message that bringing these cases to the United States is too dangerous.”
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What does the Ebola outbreak reveal about the state of global health security?
Experts say the state of global health security remains fragile, attributing some of the virus’ rapid spread to reduced foreign aid levels globally, the dismantling of USAID, and the weakening of the CDC. The current situation is “a microcosm of the larger geopolitical isolationism that we’re seeing,” said CFR expert Sam Vigersky, who led U.S. disaster assistance response teams in Liberia and Sierra Leone during the West Africa Ebola epidemic. Major public health threats such as Ebola should be addressed through multilateral action, not on an “à la carte basis,” he added.
The outbreak underscores the importance of sustained U.S. partnership and investment in countries such as the DRC and Uganda. Although the Trump administration is seeking some $1.4 billion from Congress to support the Ebola response, delays like the one seen in the current outbreak have not occurred for more than a decade, as the United States previously applied lessons from the 2014 West Africa Ebola outbreak, Psaki told CFR.
Meanwhile, the Trump administration’s plans to further cut billions of dollars from global health spending over the next few years have raised alarm, with experts warning that the breakdown in external support for public health and the rift between the United States and the WHO have made an already difficult problem worse.
Vigersky said that if international cooperation continues to wane and relationships are not maintained, future outbreaks will be more difficult to contain. Without continued investment in disease surveillance, local health authorities, and first responders, “the cost, for sure, will be lives lost,” he said.