Ebola outbreak in eastern democratic republic of Congo escalates beyond control

Ebola continues its relentless spread in the Democratic Republic of Congo (DRC), with no signs of slowing down. This grim assessment was confirmed on August 5th during a high-level visit by the World Health Organization’s Director-General to the eastern region of the country. Over two and a half months since the outbreak was declared on May 15th, this epidemic has become the second-largest ever recorded, marked by an unprecedented rate of transmission. Official figures from Congolese health authorities and the WHO now report 1,850 deaths out of approximately 4,000 confirmed cases, yielding a staggering fatality rate exceeding 40%.

Bundibugyo strain drives devastating toll

The Bundibugyo Ebola strain, responsible for this outbreak, has already claimed more lives in a comparable timeframe than in all previous outbreaks of this variant combined, according to data from the Africa Centres for Disease Control and Prevention (Africa CDC). During the last major epidemic in the DRC, which spanned from 2018 to 2020, it took over ten months to reach a similar death toll. “I cannot state with certainty that we have full control over this outbreak today,” admitted Africa CDC Director General Jean Kaseya in late July.

Persistent violence hampers epidemic response

Several critical factors have contributed to this unparalleled escalation. Primary among them is the delayed detection of the virus’s emergence. Eastern DRC presents an exceptionally challenging environment for medical coordination and case detection. The Ituri province, serving as the outbreak’s epicenter, frequently suffers from terrorist attacks by Uganda-based ADF militants, while numerous militias vie for control over land, minerals, and local influence. Meanwhile, large portions of North Kivu province—also affected by the epidemic—remain beyond Kinshasa’s control after being seized over a year ago by the M23, a Rwandan-backed armed group following intense clashes with Congolese forces.

Years of violence have displaced millions of people into neighboring Uganda, Burundi, and other Congolese territories, creating a severe humanitarian and security crisis. Living conditions and hygiene standards have deteriorated dramatically, further exacerbating the situation. Compounding these challenges, epidemiological surveillance and testing capabilities were initially inadequate due to insufficient resource allocation, delaying the identification and confirmation of the virus’s circulation.

Contact tracing efforts remain critically insufficient. Médecins Sans Frontières reports that in Bunia, the epidemic’s epicenter, 90% of admitted patients were not previously tracked contacts. Across Ituri province, only 59% of contacts have been monitored. The Africa CDC estimates that for each confirmed urban case, approximately 40 contacts should be traced—a target that would involve roughly 134,400 individuals, yet only 17,500 (13% of the goal) are currently being followed. Additionally, about one-fifth of recorded individuals receive no regular monitoring due to staff shortages or ongoing violence. Another alarming indicator of containment difficulties: 60% of deceased individuals died within their communities rather than in healthcare facilities.

Vaccines and treatments still in experimental phases

Despite these daunting challenges, efforts to curb the epidemic are underway. A first clinical trial for a vaccine targeting the Bundibugyo strain commenced this month at the University of Oxford, with the initial volunteer receiving the dose. The trial aims to enroll 50 adults to assess vaccine safety. The Coalition for Epidemic Preparedness Innovations (CEPI) is also funding the development of another vaccine by Singapore’s Hilleman Laboratories, with plans to rapidly produce and test doses in the DRC.

In the absence of an available vaccine for this highly virulent strain, the Africa CDC announced on August 6th its intention to massively deploy the vaccine for the Zaire Ebola strain among affected populations. While the Bundibugyo variant differs, vaccinated individuals exhibit only mild symptoms and do not succumb to the disease, according to CDC data. Additionally, over 40 patients are participating in a first trial evaluating a combination of treatments.

Africa CDC Director Jean Kaseya has also pledged to “expand the use of remdesivir across the DRC,” citing successful outcomes in neighboring Uganda, which swiftly contained an imported outbreak using the antiviral. “Uganda’s 10% fatality rate,” Kaseya noted, “is primarily attributable to the authorities’ use of remdesivir for all patients and contacts.” International health authorities warn that this epidemic could surpass the West African outbreak of 2014-2016—the deadliest on record—exceeding 11,000 fatalities.

Delayed international aid exacerbates crisis

Another critical factor fueling the outbreak’s spread has been the belated arrival of international assistance. Earlier this year, the U.S. administration suspended decades-long health and medical aid provided through USAID, significantly weakening the DRC’s response capacity. On August 5th, the U.S. State Department finally announced a new allocation of $242 million, bringing total American direct aid for Ebola response to $512 million. This funding, arriving three months after the outbreak’s onset, will enable the WHO and CDC to finance their six-month response plan, valued at $518 million. However, this amount remains far below previous U.S. expenditures on humanitarian and health aid. The United States remains the largest contributor to the Ebola response, far outpacing the European Union.