WHO declares DRC-Uganda Ebola outbreak a global health emergency

The World Health Organization has declared the latest outbreak of the Bundibugyo strain of Ebola in the Democratic Republic of the Congo and Uganda a “public health emergency of international concern”.

No approved vaccine or treatment exists for this strain. Ebola strains have killed more than 15,000 people in Africa over the past half-century. The previous West Africa outbreak, between 2013 and 2016, killed at least 11,000 people, according to the National Library of Medicine.

The epicentre of the latest outbreak is in the DRC’s northeastern province of Ituri, near the borders with Uganda and South Sudan. The area’s role as a gold-mining hub means people cross frequently. The virus has spread to neighbouring provinces in the DRC, as far as 200km (125 miles) from what has been identified as the epidemic’s ground zero, and has also crossed beyond the country’s borders.

Health Minister Samuel Roger Kamba said on Tuesday that the death toll had risen to an estimated 131 from 513 suspected cases in the DRC. Over the previous 24 hours, 26 more cases had been suspected.

In Uganda, the WHO said at least one person had died and two others had been infected with the latest strain. Uganda government spokesperson Alan Kasujja told Al Jazeera’s Catherine Soi that more than 120 people were being quarantined and said he was confident Uganda could control the spread of the virus.

Fear has spread in both countries. In the DRC, from Bukavu to Kinshasa, residents and street vendors have expressed concern as cases rise. People in cities hundreds of miles apart are wearing face masks and calling for stronger protections.

“I am afraid of bringing the disease home to my family because I spend the whole day transporting people. I am afraid of dying, that is what scares me so much,” a motorbike driver in the country told Al Jazeera.

“Last time [between 2013 and 2016], it killed a lot of people and we heard that it has reappeared, which makes us very afraid. Especially those of us who sell things in the street. We are in contact with people we do not know and that really frightens us,” Marie Evuto, a street vendor, said.

WHO chief Tedros Adhanom Ghebreyesus said on Tuesday that he was “deeply concerned about the scale and speed of the epidemic”.

“Early on Sunday, I declared a public health emergency of international concern over an epidemic of Ebola disease in the Democratic Republic of the Congo and Uganda,” Tedros told the World Health Assembly in Geneva.

The Bundibugyo strain is a distinct species within the Ebola virus family. Krutika Kuppalli, associate professor at the Infectious Diseases and School of Public Health at UT Southwestern Medical Center in Dallas, Texas, said it differs from the Zaire Ebola virus strain that caused the large 2014-2016 West Africa outbreak.

“While Bundibugyo has caused fewer outbreaks historically, it is still a very serious pathogen. Prior outbreaks have had case fatality rates ranging from approximately 30-50 percent, and the current outbreak is particularly concerning because there are currently no licensed vaccines or specific therapeutics for Bundibugyo virus disease,” she said.

Kuppalli said ongoing conflicts in the region, population displacement, weak surveillance systems and delayed detection would make the outbreak harder to contain.

“Early cases may have been missed in part because many front-line diagnostic platforms were optimised for Zaire Ebola virus and do not reliably detect Bundibugyo virus,” she said.

“We are now seeing this strain of the virus spread into urban and cross-border settings, which raises concern about amplification if containment measures are not rapidly strengthened,” she warned.

There is currently no approved vaccine for this Ebola strain. Ervebo, manufactured by Merck and used against the Zaire strain, has shown some protection against Bundibugyo in animal studies.

Kuppalli said vaccine development timelines are difficult to predict.

“The scientific community is not starting from zero as there is already extensive knowledge from prior Ebola vaccine work, including viral vector and mRNA platforms that could potentially be adapted for Bundibugyo virus,” she said.

“However, moving from candidate design to clinical trials, manufacturing, regulatory review, and deployment still takes time, particularly during an active outbreak in resource-limited settings,” she added.

She said organisations such as CEPI have already recognised the need for broader multivalent filovirus vaccines that could protect against multiple Ebola species, including viruses that have not yet emerged widely in humans.

“CEPI has recently funded research specifically focused on broadly protective filovirus vaccines and rapid-response vaccine platforms. Their work reflects a growing recognition that relying on species-specific vaccines leaves the world vulnerable when a different Ebola species emerges,” she said.

Until a vaccine is developed, a WHO official said on Tuesday that medical supplies, including personal protective equipment to prevent Ebola, were due to arrive in the DRC.

“We have sent 12 tonnes of supply. An additional six are arriving today. These include personal protective equipment for front-line health workers [and] samples,” Anne Ancia, WHO representative in the DRC’s Ituri province, told media.

Jean-Jacques Muyembe, a virus expert at the DRC’s National Institute of Biomedical Research, said the country was also expecting shipments of an experimental vaccine for different types of Ebola from the United States and the United Kingdom.

Many countries have raised concerns about the outbreak. Some, including Bahrain, have suspended the entry of foreign travellers arriving from South Sudan, the DRC and Uganda for 30 days. Rwanda has also closed its borders with the DRC.

The United States has imposed a 30-day temporary entry restriction for non-US citizens and non-permanent residents who have travelled to the DRC, Uganda or South Sudan within the previous 21 days. Governments across Asia have also begun introducing border screening and strengthening quarantine preparedness.

Kuppalli said there was not the same urgency about developing an Ebola vaccine as there was during the COVID-19 pandemic.

“COVID-19 vaccine development moved at unprecedented speed because the outbreak affected wealthy countries and rapidly disrupted the global economy,” she said.

“African outbreaks have historically not generated the same urgency, financing, manufacturing investment or political attention despite causing devastating local consequences,” she said.

Kuppalli said Ebola vaccine development after the 2014 outbreak accelerated only after thousands of people had already died in West Africa.

“I do think there has been progress since 2014. Global partnerships involving WHO, CEPI, GAVI, African scientists, regulators and research institutions are much stronger than they once were,” she said.

“The challenge now is ensuring sustained investment before crises become global threats, rather than only responding once outbreaks reach high-income countries. This outbreak underscores why equitable investment in epidemic preparedness and vaccine research matters not just for Africa, but for global health security overall,” she added.