Countries elsewhere must learn from the continent’s example and combat disease outbreaks by working together, not by closing borders, writes Safura Abdool Karim in the journal Nature.
Abdool Karim writes:
The latest outbreak of Ebola in the Democratic Republic of the Congo (DRC) and Uganda is one of the largest on record, with more than 3 200 cases confirmed since April, and around 1 500 deaths.
Dozens of governments and health organisations are supporting the public-health response, caused by the Bundibugyo species of Ebola virus, with their approaches revealing how global health is evolving after US cuts to international aid.
After closing the US Agency for International Development and cutting budgets for medical projects overseas in 2025, America’s federal government is now focused on preventing Ebola from crossing its own borders.
In May, it imposed travel bans for foreign nationals entering from the DRC, Uganda and South Sudan. A field hospital in Kenya was funded to hold exposed and infected Americans locally, rather than repatriating them. Canada and the Bahamas have also imposed travel bans.
The Africa Centres for Disease Control and Prevention (Africa CDC) and the World Health Organisation (WHO) have criticised these travel bans as lacking a scientific basis. Evidence shows that such restrictions do little to contain the spread of Ebola (C Poletto et al). They often create economic harm by disrupting supply chains, cross-border trade and tourism (YK Bazak et al).
By contrast, the approach co-ordinated by Africa CDC centres on evidence-based measures such as community reporting, case isolation and infection-control protocols in healthcare facilities, all coupled with community engagement.
In my view as an expert in pandemic-preparedness governance who worked on vaccine access during the Covid-19 pandemic, this co-operative model is the most effective and ethical way to deal with future epidemics and pandemics. Other nations must support it.
Within days of confirming that Ebola was circulating in humans in the DRC and Uganda, Africa CDC declared a ‘public health emergency of continental security’.
Past declarations have been issued by the WHO and designed to alert the international community to the risk of cross-border spread. They have often been slow to come, for example, the 2014 Ebola declaration in West Africa followed months of transmission and more than 900 deaths.
But this time, Africa CDC treated the declaration as means to mobilise assistance, rapidly co-ordinating with the WHO to contain the outbreak and direct resources to where they are most needed, under a single plan, budget and team.
The DRC has increased bed capacity in health facilities, established a decentralised testing network across the affected region and created screening and referral units to identify and triage cases. How and where to focus resources and efforts is being determined by the DRC and for its population, rather than to limit transmission across borders.
At a high-level meeting of African Ministers of Health that I attended in May, several countries pledged support in cash or kind for the DRC response, asking for nothing in return.
I repeatedly heard Ministers emphasise the need for solidarity with the DRC. This stands in contrast to the bilateral agreements that the United States is signing with other nations. These require receiving countries to meet a range of stipulations, including providing access to their disease data with no reciprocal access to US data, and commitments to co-fund substantial portions of pandemic-preparedness and surveillance efforts.
This is only the second emergency response Africa CDC has co-ordinated, and involves serious challenges. It is trying to manage an outbreak in an active conflict zone with limited resources, fledgling infrastructure and fragmented surveillance systems.
Critics might note that Africa CDC’s response to the 2024 mpox outbreak had gaps. Vaccines never materialised at scale; testing was concentrated in Kinshasa, with decentralisation too slow; and point-of-care testing was deployed in only a handful of provinces.
These are meaningful shortcomings, but the Ebola response shows that the organisation is learning. Its approach – a rapid, evidence-based, properly resourced response – is the best way to stop an outbreak from becoming an international public-health emergency.
To build outbreak preparedness, Africa CDC must continue to increase regional lab capacity, so that analysis of emerging pathogens happens rapidly and locally. It must establish more pathways to collect and reliably share outbreak data across countries in real time.
And other nations must make three commitments: join responses co-ordinated by Africa CDC and the WHO; follow evidence-based interventions; and support outbreak responses in affected countries rather than focusing on border protection.
In the longer term, there is an urgent need to agree on the multilateral pandemic treaty, negotiations for which have stalled.
Some high-income countries want access to other nations’ pathogen data while providing limited or no access to the medical countermeasures developed from those data, whereas the African bloc demands equitable access as a condition of data-sharing.
Countries need to approach the negotiations with the goal of supporting a collective response.
Recent instances of mpox, hantavirus and now Ebola show that – in an interconnected world facing increasingly frequent outbreaks – closing borders is no way to prevent pandemics.
The current Ebola crisis is a pivot point. How countries respond will shape the future of global health.
Safura Abdool Karim is head of pandemic preparedness and response and senior scientist at the Centre for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, Durban.
See more from MedicalBrief archives:
Ebola response highlights the value of African science
SA prepares for Ebola outbreak as DRC health workers threaten strike
Thousands missed in Ebola contact tracing, warns Africa CDC
Africa needs to strengthen readiness for public health threats