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A new Lancet analysis explores the challenges and priorities for epidemic preparedness and response during the ongoing Bundibugyo virus Ebola outbreak in the Democratic Republic of the Congo and Uganda.

With the WHO declaring the Bundibugyo virus (BDBV) Ebola outbreak in DR Congo and Uganda a Public Health Emergency of International Concern, and Africa CDC declaring it a public health emergency of continental security, a team of leading African scientists and public health officials has published an urgent analysis in The Lancet. As of June 3, 2026, 344 laboratory-confirmed cases and 60 deaths had been recorded in DR Congo, with Uganda reporting 15 confirmed cases and one death. Cross-border transmission has prompted heightened alarm across the region. The outbreak is particularly dangerous because no licensed vaccine or approved therapeutic currently exists for BDBV – and early diagnosis is severely hampered by limited access to suitable point-of-care tests. This paper, led by Jean Nachega, Placide Mbala-Kingebeni, and Jean-Jacques Muyembe-Tamfum, draws on the work of INRB, UVRI, IVI, and Stellenbosch University to map the barriers standing in the way of control – and the actions needed to overcome them.

Prof Tulio de Oliveira, Director of the Centre for Epidemic Response and Innovation (CERI) at Stellenbosch University, says: “I am honoured to collaborate with leading African scientists and public health officials on the Ebola outbreak. In our article published in The Lancet, we discuss the challenges and priorities for epidemic preparedness and response.

We identify six key barriers to controlling the Bundibugyo virus outbreak and outline priority response actions:

1. Community mistrust, misinformation, and resistance to isolation and safe burial practices.
2. Armed conflict, insecurity, population displacement, and cross-border mobility
3. Delayed diagnosis and limited decentralised testing capacity.
4. Fragile health systems and gaps in infection prevention and control.
5. Absence of licensed Bundibugyo virus vaccines or therapeutics and limited outbreak research capacity.
6. Episodic financing and reactive preparedness.

Additionally, we highlight key priorities to support the teams responding directly to the outbreak. Significant work is being done by INRB, UVRI, IVI, and Stellenbosch University.”

What the Paper Says

On community trust and engagement:

The authors highlight how fear, stigma, misinformation, and conspiracy narratives have undermined surveillance, testing, isolation, contact tracing, and vaccination across eastern DR Congo – particularly in communities that perceive infection control measures as externally imposed rather than co-developed. Reports of attacks on health facilities, patients fleeing treatment centres, and disputes over burial practices underscore how quickly trust can erode when dignity and transparency are deprioritised.

The paper calls for community-led approaches: engaging traditional healers, survivor networks, women’s organisations, youth leaders, and local media as active partners in early detection and risk communication – not afterthoughts. Trust-building, the authors argue, must be treated as a core operational component of outbreak control, not a secondary communication exercise.

On armed conflict and cross-border spread:

DR Congo is experiencing one of the world’s largest displacement crises, with approximately 6.9 million internally displaced people – most in the eastern provinces at the heart of this outbreak. Informal trade, mining, agricultural work, and health-seeking behaviour regularly cross administrative and national borders, while ongoing insecurity disrupts field operations, delays laboratory confirmation, and restricts humanitarian access. The paper calls for harmonised surveillance across DR Congo, Uganda, Rwanda, and South Sudan, with shared line lists, joint contact tracing, and coordinated screening at border entry points.

On diagnostics:

Early Ebola virus disease – including BDBV infection – closely resembles malaria, typhoid, cholera, and Lassa fever, making clinical recognition difficult. Critically, most existing near-patient molecular assays are designed to detect Ebola virus (EBOV) and may not reliably detect BDBV or Sudan virus. The authors call for urgently expanding decentralised near-patient diagnostics, safe specimen transport, and pan-filovirus assay platforms capable of detecting all orthoebolaviruses, validated for field use.

On health systems and the research gap:

No approved vaccine or virus-specific therapeutic currently exists for BDBV – in stark contrast to EBOV, for which licensed vaccines and monoclonal antibody therapies are available. Preliminary genomic analyses suggest the current outbreak stems from a new zoonotic spillover event rather than sustained human-to-human transmission from earlier outbreaks – a finding rapidly generated and shared by scientific teams in DR Congo and Uganda within 48 hours of laboratory confirmation, demonstrating the growing power of Africa-led genomic surveillance.

The authors also flag critical knowledge gaps around BDBV’s clinical spectrum in pregnant women, children, and people living with HIV, as well as long-term survivor sequelae including ocular, neurocognitive, and mental health complications. Clinical research must be embedded in the response from the outset, with adaptive trial platforms prepared for candidate vaccines, monoclonal antibodies, and antivirals.

On financing:

Repeated Ebola outbreaks in DR Congo – alongside mpox, cholera, and COVID-19 amid persistent conflict – have exposed the limits of reactive models that surge during emergencies and collapse when international attention fades. The authors call for durable preparedness financing and stronger national public health institutes, moving beyond episodic emergency funding toward sustained regional resilience.

 

Authors: Jean B Nachega, Placide Mbala-Kingebeni, Sabue Mulangu, Nicaise Ndembi, Wolfgang Preiser, Donald Skinner, Nadia A Sam-Agudu, Francine Ntoumi, Houriiyah Tegally, Cheryl Baxter, Tulio de Oliveira, Henry Kyobe Bosa, Pontiano Kaleebu, Oscar Kallay, Olalekan A Uthman, Edward J Mills, Philip J Rosenthal, Alimuddin Zumla, Jean-Jacques Muyembe-Tamfum.

Read the full paper here 

 

 

News date: 2026-07-31

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