The intersection of armed conflict and infectious disease has once again placed global health security at risk. The current Ebola outbreak in the Democratic Republic of Congo (DRC) highlights a convergence that is challenging to manage. The DRC and nearby Uganda declared the outbreak on 15 May 2026, while the World Health Organization (WHO) declared it a Public Health Emergency of International Concern just 48 hours later. The Africa Centres for Disease Control and Prevention (CDC) followed suit, declaring it a Public Health Emergency of Continental Security (PHECS). The outbreak likely began much earlier, with reports of a mysterious disease in the gold-mining town of Mongbwalu and nearby regions emerging as early as April. Current estimates report 138 deaths and 695 confirmed cases. The ongoing outbreak is characterised by three main factors: weakened community-based disease surveillance, the effects of conflict and displacement on health system functioning, and the lack of an approved vaccine or specific therapeutic agent. Collectively, these factors render the outbreak susceptible to becoming unmanageable and underscore the need for better preparedness.
Bundibugyovirus and Delayed Detection
Ebola virus disease occurs when a person is infected with a virus that causes haemorrhagic fever, severe tissue inflammation and damage, and, if left untreated, can be life-threatening. In humans, three different viruses—Ebolavirus, Sudan virus, and Bundibugyo virus—are known to cause large-scale Ebola outbreaks. The largest and most severe outbreak, caused by Ebolavirus, was the 2014–2016 West Africa outbreak, during which over 28,600 cases were reported. The current outbreak is attributed to Bundibugyovirus (BDBV), marking the third time it has been detected in humans; previous outbreaks occurred in 2007 and 2012. The fatality rate for BDBV is reported to be between 30 and 50 percent, lower than that of the West Africa outbreak, which had a fatality rate of 63 percent.
This highlights the need for point-of-care BDBV-specific or pan-filovirus diagnostics as part of an Ebola preparedness system. Delayed detection of BDBV, coupled with its non-specific clinical presentation, led to undetected transmission events.
These viruses are of zoonotic origin, and studies suggest that fruit bats in the family Pteropodidae are their natural reservoir. Transmission occurs when humans are in close contact with blood or secretions of animals that carry the virus. Human-to-human transmission occurs in close contact settings such as healthcare settings, when a person comes into direct contact with the blood or bodily fluids of a sick individual or from a deceased individual, as well as through contaminated inanimate objects and surfaces. Symptoms appear between 2 and 21 days after infection and initially overlap with other viral haemorrhagic fevers and diseases such as malaria, complicating diagnosis.
Reports of a mysterious illness in the remote gold-mining town of Mongbwalu in Ituri Province, DRC, which had already claimed lives, emerged in April 2026, but surveillance and diagnostic limitations delayed recognition of an Ebola outbreak. GeneXpert diagnostic kits failed to detect BDBV as they were designed to detect Ebolavirus, potentially allowing undetected transmission. Later, pan-filovirus PCR assays—assays that detect a broad range of viruses—alongside sequencing approaches, were used to detect BDBV cases. Obtaining diagnostic kits and reagents for sequencing faced logistical delays because they required specialised equipment and trained personnel.
This highlights the need for point-of-care BDBV-specific or pan-filovirus diagnostics as part of an Ebola preparedness system. Delayed detection of BDBV, coupled with its non-specific clinical presentation, led to undetected transmission events. This is concerning because delayed detection events have previously been associated with larger and longer Ebola outbreaks.Â
Spillover Risks
The outbreak also points to the need for a deeper understanding of the interconnectedness between humans, plants, animals, and the planet, or the One Health approach. While fruit bats are considered the natural reservoir of BDBV, there is a lack of definitive scientific evidence to explain how zoonotic spillover events occur, whether any intermediate hosts exist, and the precise mechanisms of transmission from hosts to humans. Ituri Province possesses rich bat biodiversity, with caves and dense forest canopies that act as roosting sites for bats. Further, the region contains artisanal gold-mining communities and is densely populated. Habitat loss and degradation have likely contributed to biodiversity loss and are likely to be responsible for frequent spillover events in the region. Cross-border mobility through this porous region has likely resulted in the spread of the outbreak to Uganda, which has reported 19 BDBV cases and two deaths as of 10 June 2026. Studies on virus-human interaction show that a tightly linked ecosystem between bats and humans can facilitate spillover events. For instance, close physical contact with bats through droppings, contaminated fruits, or bushmeat can facilitate transmission.
Conflict and the Erosion of Health Security
The DRC is also marked by conflict and insecurity since the 1994 Rwandan genocide. Ethnic tensions and political violence, particularly in Ituri, located along the DRC–Rwanda border, over land resources and mineral extraction among militant and ethnic organisations, dominate the region. Large reserves of rare-earth metals and minerals have incentivised more groups, including American and Chinese multinational mining companies, to become involved in the conflict. In addition to the six million deaths since 1996, approximately 5.6 million people have been displaced within the DRC, and an estimated 26.5 million people suffer from food insecurity. Against this backdrop, the DRC has also experienced repeated Ebola outbreaks; the ongoing outbreak is the 17th Ebola outbreak in the DRC.
Large reserves of rare-earth metals and minerals have incentivised more groups, including American and Chinese multinational mining companies, to become involved in the conflict. In addition to the six million deaths since 1996, approximately 5.6 million people have been displaced within the DRC, and an estimated 26.5 million people suffer from food insecurity.
Despite a peace agreement—the Washington Peace Accords for Peace and Prosperity—between the DRC and Rwanda being signed in 2025, clashes between M23, a Rwanda-backed militant group, and the DRC are ongoing. Cycles of conflict have weakened the health infrastructure and road connectivity needed to access health services. Security measures hamper the movement of health workers, food, and medical supplies, while attacks on healthcare facilities have prevented access to critical health needs. The DRC was the most affected African country by United States Agency for International Development (USAID) cuts, creating gaps in disease surveillance and monitoring measures. Displacement of people from the conflict-affected region makes contact tracing difficult. Disruptions in economic activity, such as trade and agriculture, have exacerbated poverty, contributing to the country’s severe food insecurity. Political violence has created an environment of fear, mistrust, misinformation, and disinformation, hampering measures to contain viral spread.
For instance, mistrust has fuelled debate over the origin of BDBV—questioning its existence, casting suspicion over whether aid workers’ presence in the region is to help local communities or to gain access to the region's minerals, and whether the outbreak is a result of a deliberate bioweapon attack. As a result, suspected individuals have fled Ebola triage stations, making contact tracing and attempts to minimise transmission difficult. These tensions have resulted in attacks on medical professionals and hospital infrastructure. Previous Ebola outbreaks emphasised the importance of detection and surveillance, where strong, coordinated, community-centric responses helped contain and stop the spread of the virus. This is essential as early supportive care is the only life-saving intervention for BDBV infection.
The importance of communicating precautionary measures within cultural contexts was highlighted in Dorothy Crawford's book, Ebola: Profile of a Killer Virus.
The importance of communicating precautionary measures within cultural contexts was highlighted in Dorothy Crawford's book, Ebola: Profile of a Killer Virus. This includes educating people about the need for safe burial practices, implementing triage systems with transparent dividers, promoting behaviours that minimise exposure to potential sites of transmission, and providing reassurance that spread can be relatively easily contained compared to airborne viruses.
Closing the Preparedness Gap
There are no approved vaccines or therapeutics for BDBV. This demonstrates a paradox in preparedness: the licensed Ebola vaccine (for Ebolavirus), Ervebo, offers limited cross-protection against other ebolaviruses, while the limited number of BDBV outbreaks has provided little opportunity or incentive to develop and evaluate candidate vaccines. Nevertheless, WHO expert and advisory groups have recommended that several treatments and vaccine candidates be evaluated in clinical trials as a priority. These include monoclonal antibody therapies such as MBP134 and Maftivimab®, the antiviral remdesivir, and the post-exposure prophylaxis obeldesivir. Investigational vaccine candidates include the rVSV Bundibugyo vaccine (developed by the International AIDS Vaccine Initiative) and the ChAdOx1 Bundibugyo candidate (developed by the University of Oxford and the Serum Institute of India). The Coalition for Epidemic Preparedness Innovations (CEPI) announced plans to invest US$ 60 million in the rapid R&D of these two vaccine candidates, as well as Moderna's mRNA vaccine candidate for BDBV, while Gavi, the Vaccine Alliance, will add US$ 50 million to ensure high-volume production and access. The Pandemic Fund has pledged US$ 220.6 million to fill gaps in the response to the outbreak.
There are no approved vaccines or therapeutics for BDBV. This demonstrates a paradox in preparedness: the licensed Ebola vaccine (for Ebolavirus), Ervebo, offers limited cross-protection against other ebolaviruses, while the limited number of BDBV outbreaks has provided little opportunity or incentive to develop and evaluate candidate vaccines.
Conclusion
The US Centres for Disease Control and Prevention (CDC) models have predicted that the ongoing outbreak could become as large as the 2014–2016 West Africa outbreak. Until a safe and efficacious vaccine is approved for use against BDBV, community-centric public health interventions must take primacy. The DRC poses a unique challenge, where severely weakened health infrastructure, armed conflict, and displacement can thwart efforts to contain a viral outbreak. Employing rapid, point-of-care diagnostics for BDBV to enhance surveillance and detection, alongside raising awareness of behaviours and practices that facilitate transmission to and among humans, remains critical at this juncture.
Lakshmy Ramakrishnan is an Associate Fellow with the Centre for New Economic Diplomacy at the Observer Research Foundation.
The author acknowledges the use of ChatGPT-5.5 (OpenAI) to identify repetitive sections and suggest reductions in word count.
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