A Stellenbosch University-led team of scientists who collaborated with regional experts to assess the ongoing Ebola outbreak in the DRC and Uganda – and published their findings in The Lancet as a commentary – highlighted not only healthcare system pressures, but also the social, economic and political factors complicating outbreak response.
Lead author Professor Jean Nachega, director of Stellenbosch University's Biomedical Research Institute, said their report also details the broader social, economic and political conditions that complicate outbreak response and care delivery.
Additionally, the research team, which included a co-discoverer of the Ebola virus, Professor Jean-Jacques Muyembe-Tamfum from the Institut National pour la Recerche Biomedicale in the DRC, presented a set of recommendations to strengthen the public health response to the epidemic in the region.
Study details
Ebola outbreak caused by Bundibugyo virus: challenges and priorities for epidemic preparedness and response
Jean Nachega, Placide Mbala Kingebeni, Sabue Mulangu, Nicaise Ndembi, Wolfgang Preiser, Donald Skinner et al.
Published in The Lancet on 9 June 2026
Since WHO declared the ongoing outbreak of Ebola virus disease caused by Bundibugyo virus (species Orthoebolavirus bundibugyoense; BDBV) a public health emergency of international concern and the Africa Centres for Disease Control and Prevention (Africa CDC) declared a public health emergency of continental security, the outbreak has continued to evolve rapidly.
It poses a substantial public health threat because diagnosis is often delayed by limited access to suitable point-of-care assays, and no licensed vaccine or approved virus-specific therapeutic exists.
Armed conflict in the region, with population displacement, fragile health systems, and intense cross-border mobility, are complicating control efforts.
DR Congo is experiencing one of the world’s largest displacement crises – 6.9m internally displaced people – most of them in the eastern provinces affected by recurrent conflict and epidemic threats.
Informal trade, mining activities, agricultural work, displacement, and healthcare-seeking frequently occur across borders, while insecurity can interrupt field operations, delay laboratory confirmation, and restrict humanitarian access to affected communities.
In the short term, strengthening cross-border co-ordination through harmonised surveillance definitions, shared line lists, interoperable laboratory reporting, joint contact tracing, co-ordinated points-of-entry screening, and regular information exchange between DR Congo, Uganda, Rwanda, South Sudan, WHO, and Africa CDC will be essential.
It is also crucial to protect front-line healthcare workers through adequate supplies of PPE, refresher training in infection prevention and control, triage protocols, safe specimen handling, psychosocial support, and rapid investigation of healthcare-associated infections.
Decentralising diagnostics, maintaining humanitarian access, and expanding sustained community-based engagement will also be essential. Over the longer term, more resilient regional surveillance and response systems are needed in areas repeatedly affected by conflict, displacement, and recurrent epidemic threats.
Operational challenges are compounded by long-standing mistrust of public institutions and previous experiences of delayed or inadequate outbreak responses.
Risk communication and community engagement activities led by ministries of health, WHO, Africa CDC, local civil society organisations, religious leaders, survivor networks, and community health workers are ongoing in affected areas, however, implementation remains uneven because of the challenging context.
Reports of attacks on healthcare facilities, patients fleeing treatment centres, reluctance to disclose contacts, and disputes over burial practices during previous and current outbreaks of Ebola virus disease, illustrate how rapidly public trust can erode when dignity, communication, and transparency are insufficiently prioritised.
Trust, dignity, and community legitimacy must remain central to epidemic preparedness and response. Culturally sensitive risk communication, engagement with trusted community leaders and survivor networks, family liaison systems, and community-led approaches to safe and dignified burials are essential.
Informal and community-based healthcare systems remain central. Individuals with early symptoms often seek care from traditional healers, pharmacies, faith-based providers, private clinics, or under-resourced public facilities before reaching Ebola treatment services.
Although these pathways can delay diagnosis and referral, they also represent important opportunities for early case detection, trusted communication, stigma reduction, and safe referral. Public health responses that fail to engage these networks risk missing crucial points of community contact.
Effective community engagement requires the co-creation of culturally acceptable, locally relevant solutions that acknowledge community beliefs, priorities, and lived experiences.
Trust-building should be viewed not as a secondary communication activity but as a core operational component of outbreak control and a prerequisite for sustained confidence in health systems and public health authorities.
Challenges related to early diagnosis due to lack of a reliable rapid diagnostic test also delay isolation, supportive care, contact tracing, and infection prevention and control measures, increasing opportunities for transmission.
Early Ebola virus disease, including that caused by BDBV infection, can resemble malaria, typhoid fever, cholera, Lassa fever, and other endemic febrile illnesses, making early clinical recognition and triage challenging. Most near-patient molecular assays are designed to detect Ebola virus (species Orthoebolavirus zairense; EBOV), which has caused most previous outbreaks of Ebola virus disease, but might not reliably detect Sudan virus (Orthoebolavirus sudanense) or BDBV.
Ideally, field-deployable assays should detect any member of the genus Orthoebolavirus without necessarily distinguishing between species. Broad-range molecular assays and sequencing-based approaches capable of detecting multiple orthoebolaviruses and other filoviruses are increasingly available, and next-generation pan-filovirus diagnostic platforms are under active development; however, field validation, regulatory approval, and implementation remain limited.
In the immediate term, decentralised near-patient molecular diagnostics for Ebola virus disease, rapid and safe specimen transport, and strengthened regional lab networks are urgently needed.
These should be supported by trained lab and clinical staff, reliable supply chains for reagents and PPE, biosafety and biosecurity systems, external quality assurance, digital reporting platforms linked to surveillance teams, and clear protocols for referral and clinical triage.
However, implementation remains challenging.
Future investments should include validated pan-orthoebolavirus or even pan-filovirus assays, strengthened biosafety systems, and resilient laboratory infrastructure integrated into routine public health surveillance rather than activated only during emergencies.
Over the longer term, candidate BDBV vaccines, pan-orthoebolavirus monoclonal antibodies, antivirals, and adaptive clinical trial platforms should be strengthened through existing and expanded Africa-led research partnerships, including national public health institutes, regional clinical trial networks, WHO, Africa CDC, and national regulatory authorities, supported by regional regulatory harmonisation through mechanisms like the African Medicines Agency and African Vaccine Regulatory Forum.
These efforts should be matched by One Health surveillance that links human, animal, environmental, and ecological data in areas where mining, deforestation, displacement, wildlife contact, and livelihood disruption might increase opportunities for zoonotic spillover.
Preliminary genomic analyses suggest that the current outbreak is associated with a new zoonotic spillover event rather than sustained human-to-human transmission linked to previously recognised BDBV outbreaks.
The rapid generation and sharing of genomic sequences by scientific teams in DR Congo and Uganda within 48 hours of lab confirmation shows the growing importance of Africa-led genomic surveillance capacity and real-time data sharing-during infectious disease emergencies.
This outbreak also highlights persistent inequities in access to research and medical countermeasures for non-EBOV filoviruses.
Although licensed vaccines and monoclonal antibody therapies are available for Ebola virus disease caused by EBOV, no approved vaccine or virus-specific therapeutic currently exists for BDBV.
Important knowledge gaps also persist regarding the clinical spectrum and long-term consequences of BDBV infection, particularly among pregnant women, children, and people with HIV or other co-infections.
Clinical research should therefore be embedded within the response from the outset, with ethical, regulatory, community, and logistical preparedness for adaptive trials of candidate vaccines, monoclonal antibodies, antivirals, and post-exposure prophylaxis strategies relevant to BDBV and other non-EBOV orthoebolaviruses.
The immediate priorities are clear: protecting healthcare workers and the most vulnerable populations, restoring community trust, strengthening cross-border co-ordination, decentralising diagnostics, ensuring safe and dignified burials, and sustaining surveillance and case management in affected settings.
However, many of the structural vulnerabilities cannot be resolved through short-term emergency mobilisation alone.
Repeated Ebola virus disease outbreaks in the DRC, alongside mpox, cholera, and Covid-19 amid persistent conflict, have exposed the limits of reactive outbreak response models that surge during emergencies but weaken once international attention declines.
This BDBV outbreak should be treated as a warning that epidemic preparedness remains uneven, episodic, and insufficiently aligned with the realities of affected communities.
Rapid diagnostics, genomic surveillance, infection prevention and control, supportive care, and accelerated countermeasure development remain essential, but will succeed only if embedded within trusted community partnerships, resilient health systems, protection of front-line workers, sustained financing, and co-ordinated regional surveillance systems.
Preparedness strategies should address the full spectrum of pathogenic orthoebolaviruses and other epidemic-prone pathogens, strengthen Africa-led research and manufacturing capacity, integrate One Health surveillance, and support the equitable development and evaluation of vaccines, monoclonal antibodies, and antivirals through adaptive trial platforms and regional regulatory collaboration.
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