JONATHAN M. METSCH, Dr.P.H. – Tracking Emerging Public Health Challenges – August 5, 2026 -EBOLA
“The Ebola epidemic in Democratic Republic of Congo is on track to surpass 4,000 cases this week and has been described as the fastest spreading on record since it was officially declared in May.
It is already the world’s second-largest epidemic after West Africa’s 2014-16 outbreak in Guinea, Liberia and Sierra Leone, when the World Health Organization recorded more than 28,000 cases and 11,000 deaths.
Delayed detection, overwhelmed surveillance, military conflict and a lack of vaccines and treatments for the species of the virus involved have allowed the disease to outrun containment efforts this time.
HOW FAST IS IT SPREADING?
A HEADSTART FOR THE VIRUS
AID CUTS AND UNPAID SALARIES
NO VACCINE, NO PROVEN TREATMENT
CONFLICT AND MISTRUST
POPULATION MOVEMENT (1)
“The U.S. State Department on Wednesday nearly doubled its financial commitment to the Ebola response in eastern Democratic Republic of Congo, announcing plans to provide an additional $242 million to combat the second-largest outbreak of the disease in history.
State Department spokesperson Tommy Pigott told reporters that the money would fund up to six months of activity and bring the total amount of direct U.S. assistance to $512 million.
Aid officials have described the outbreak as the fastest-spreading Ebola epidemic ever due to its delayed detection, surveillance system gaps, armed conflict in eastern Congo and the absence of vaccines and treatments for the strain of the virus that is circulating.”
“The U.S. has been the largest contributor to the international Ebola response. It says its funding has supported more than 180 health facilities in areas affected by the disease and procured and distributed nearly 300 tons of critical supplies.
“While we recognize that the road ahead is long and challenging, the United States’ support has unquestionably stopped this outbreak from being worse,” Pigott said.” (2)
“Maternal mortality across Ituri soon doubled as news of the outbreak spread, with an average of about six women dying per week due to childbirth complication, according to Noemi Dalmonte, deputy country representative of the United Nations Population Fund in Congo.” (4)
“Case investigators can only trace a patient back to whoever infected them if that person was caught by surveillance too. So the fraction of cases with a known infector doubles as a rough measure of how many infectors the system was finding in the first place. That is the detection rate, and dividing the confirmed count by it gives an estimate of the true number of cases.
At 46 percent, the 3,822 confirmed cases imply about 8,300 infections. I would consider that a lower bound. It is a very soft one, because the 46 percent was measured only on cases documented well enough to judge, and the sparse ones left out are precisely those least likely to have a traceable source.
The 20 percent already on a contact list sets the ceiling. Anyone on a list before they fall ill is nearly certain to be counted, so that figure understates detection. The fivefold correction it implies, around 19,000 infections, is about as far above the count as the truth can plausibly sit.
The two bounds are not symmetrical. The ceiling is firm. The floor is soft, and the way it is calculated all but guarantees the truth lies above it. WHO’s three-to-four-fold estimate sits inside the bracket, above the middle.
Publicly the agency has been more cautious. Tedros Adhanom Ghebreyesus, the director-general, has warned that the true number of cases could be “more than double” the official count. The figure the agency sent me is roughly twice that again. A European Centre for Disease Prevention and Control review from June went wider still, citing a model that put infections at 3.0 to 10.2 times reported. That interval is too wide to plan around. It also does not contain the possibility that the official count is roughly right.” (5)
“Kasenyi, located on the western shores of Lake Albert in the Ituri Province of the eastern Democratic Republic of the Congo, is a strategic crossing point at the country’s border with Uganda. Every day, people move between the two countries, fostering trade and community exchange, making this part of the Tchomia health zone—home for more than 94 000 people—particularly vulnerable to the spread of epidemic-prone diseases. In such a context, the speed of diagnosis can make all the difference in interrupting Ebola transmission and protecting both communities and health workers.
To this end, the Democratic Republic of the Congo and Uganda have strengthened diagnostic capacity in Kasenyi through the deployment of a mobile laboratory, with support from the World Health Organization (WHO) and partners. This joint action aims to bring Ebola disease diagnostic services closer to communities living in this border area and to accelerate the confirmation of suspected cases.
“The mobile laboratory was installed here because positive cases of Bundibugyo virus disease were recorded in the Tchomia health zone. Its deployment allows rapid confirmation of cases, supports cross-border surveillance and helps interrupt the chain of transmission,” explained Dr Olga Ntumba Tshitenge, laboratory focal person at WHO in the Democratic Republic of the Congo.” (3)
“When the Covid-19 epidemic erupted, N95 masks were the top need. In a cholera outbreak, oral rehydration salts and IV fluids are crucial. In eastern Democratic Republic of Congo, where Ebola has killed more than 1,500 people, the critical shortage is in trust.
With Ebola spreading rapidly in eastern DRC, Bilali Emmanuel David Lingo and his colleagues from the International Organization for Migration scan thousands of people each day crossing into South Sudan, watching for high fever and other signs of potential infection. “The risks are very high; they are moving closer to our borderlines,” said Lingo, a 41-year-old South Sudanese nurse who has worked for more than a decade for the IOM, a United Nations agency.
In the first two months since the outbreak was reported in May, IOM screened about 700,000 people at South Sudan border posts and reached nearly half a million people with Ebola awareness messages. On market days, the busiest crossings see as many as 1,500 people, Lingo said. Those who show signs of possible infection are isolated while samples are sent for testing; so far, no confirmed cases have turned up among border crossers.
Local staff are trained in infection prevention and control, and IOM materials educate travelers on Ebola’s symptoms, including fever, vomiting, severe headaches, and fatigue. Beyond the formal crossings, people also enter South Sudan through informal routes that aren’t monitored.
Overcoming distrust is a challenge. “We try to inform them that Bundibugyo (Ebola) virus is real and everyone has to be vigilant, from the communities to the family level,” Lingo said. “Through proper education, patience and awareness, we’ve seen that these beliefs and mistrust are changing.” (7)
“Patients with confirmed Ebola Bundibugyo virus receive care within a treatment centre’s “red zone”, as distinct from the “green zone” which is accessible to the public. The DRC Government, UN agencies and partners are scaling up the response.
With support from the United States, the NGO International Medical Corps (IMC), has set up an Ebola transit centre at the Kigonze displacement camp on the outskirts of Bunia, capital of Ituri.
The facility will make it easier to identify suspected cases more quickly and refer confirmed Ebola patients to treatment centres. This will help contain the spread of the virus in the displacement site, an OCHA spokesperson said.
This week, IMC will also inaugurate the biggest treatment centre of the country, with 100 beds. Overall capacity for the Ebola response is approximately 900 beds.
However, a substantial scaling up of response activities is needed to get ahead of the outbreak, which has seen increasing number of cases, expanding geographic spread and high mortality, WHO has warned.
“The convergence of insecurity, population displacement and mobility and cross-border movements complicate response operations and increase the risk of further geographical spread,” the UN agency said, noting that around 270,000 people who have fled violence now live in displacement sites across Ituri province, where conditions are ideal for the disease to spread.” (6)
“We are now witnessing another big Ebola outbreak in Africa, this time centered in the Democratic Republic of Congo, with fearful people distrusting health workers and even attacking treatment centers. That has me thinking back to 12 years ago when I served as the Peace Corps country director in Guinea. While the Peace Corps volunteers were sent home as a precaution, I stayed behind with our mostly Guinean staff to support the U.S. Centers for Disease Control and Prevention (CDC) effort to contain this highly infectious disease.
Many Guineans were highly skeptical about Ebola, and there were many rumors and widespread resistance. Many who had contact with Ebola went into hiding, and there were incidents of crowds attacking government convoys. My staff used our deep community connections to educate citizens about the disease and the precautions required. We trained homemakers, teachers, students, youth leaders and others about common rumors and how to overcome fear and resistance back home.
These newly trained community educators went back to their villages and developed a personal action plan starting with one-on-one conversations with family members, neighbors and others they knew. As they gained confidence and support, they moved to others in their community, including speaking in small groups. These respected community members gained credibility, earned respect and developed trust as volunteers. They asked open-ended questions and did not judge people. They applied participative approaches to learning, used their local languages and adapted messages to the community level. They were trained to use role-playing techniques that helped them communicate effectively.
Ultimately, this initiative was estimated to reach 3.2 million people, one quarter of Guinea’s population, and that Ebola outbreak was largely ended. U.S. Ambassador Dennis Hankins wrote, “Peace Corps local staff were able to make a key contribution in fighting Ebola. Through their collective efforts, I am convinced hundreds if not thousands of lives were saved.” (8)
1.Explainer: Why Congo’s Ebola outbreak is spreading faster than previous epidemics, By Clement Bonnerot and Jessica Donati, https://www.reuters.com/business/healthcare-pharmaceuticals/why-congos-ebola-outbreak-is-spreading-faster-than-previous-epidemics-2026-08-05/
2.US Will Nearly Double Financial Commitment to Ebola Response, By Aaron Ross, https://www.usnews.com/news/top-news/articles/2026-08-05/us-will-nearly-double-financial-commitment-to-ebola-response
3.The Democratic Republic of the Congo and Uganda bring Ebola diagnosis closer to border communities, https://www.afro.who.int/countries/democratic-republic-of-congo/news/democratic-republic-congo-and-uganda-bring-ebola-diagnosis-closer-border-communities
4.More pregnant women are dying in Congo as they avoid hospitals over Ebola, By JUSTIN KABUMBA and CHINEDU ASADU, https://apnews.com/article/congo-ebola-maternal-mortality-childbirth-outbreak-932b867b7933c36c9ebf069b90e5cd60
5.Congo Is Counting Fewer Than Half Its Ebola Cases, By John Drake, https://www.forbes.com/sites/johndrake/2026/08/04/congo-is-counting-fewer-than-half-its-ebola-cases/
6.DR Congo: New centre opens at heart of record Ebola outbreak, https://news.un.org/en/story/2026/08/1168064
7.Building Trust to Contain the Spread of Ebola in East Africa, By Paul M. Sherer, https://www.directrelief.org/2026/08/ebola-east-africa-building-trust-health-aid/
8.What I learned from Ebola, by Doug Teschner, https://www.nhbr.com/what-i-learned-from-ebola/
curated by Jonathan M. Metsch, Dr.P.H.
Clinical Professor of Environmental Medicine, Icahn School of Medicine at Mount Sinai