The outbreak of Bundibugyo ebolavirus in the Democratic Republic of the Congo is not, primarily, a story about a deadly and scary virus. It is a story about systemic failure — in diagnostics, in institutional capacity, and in countermeasure preparedness — that my colleagues and I have been warning about for years.
By the time you read this, the official case count is approaching 1000. The real number is higher. That gap isn’t a mystery — it’s the direct consequence of a diagnostic delay that gave the virus a several week head start. Bundibugyo is a rare species of Ebola, having caused just two prior outbreaks, and initial testing, targeted to the far more common Zaire species, missed it. By the time anyone knew what they were dealing with, untraced transmission chains were already in motion. Typical Ebola outbreaks get flagged when there are 20 or 30 cases, beginning containment when cases are in the triple digits with significant momentum is a different containment problem entirely.
This is exactly the kind of failure I testified about before the House Foreign Affairs Subcommittee in 2021. I argued then that we have a “biological dark matter” problem — undiagnosed clinical syndromes circulating everywhere, containing early signals we’re not catching because our diagnostic infrastructure isn’t looking for them. Far too many unknown infectious syndromes — from Pittsburgh to Bunia — go without a specific microbiologic diagnosis. The 20,000+ case West African Ebola epidemic of 2013–2016 offered the same lesson: Ebola had been circulating for over a decade mixed in with (and likely mistaken for) Lassa Fever cases. Guinea took three months to realize it was dealing with an Ebola outbreak and not cholera. The trajectory of the current DRC outbreak echoes the past.
What made this outbreak worse is that the US surveillance infrastructure that would have sounded the alarm earlier has been dismantled. USAID, which operated in the DRC, was impacted by DOGE program. In addition, the director-less and RFK Jr-beholden CDC has lost over 700 people from its emerging-disease activities — employees and contractors — including the head of the high-consequence infectious disease group directly responsible for Ebola response. The storied agency that was once first on the ground, first to brief the world, now can’t even participate directly with the WHO without asking permission.
A major aspect of the US response to all this has been a travel ban — on DRC, Uganda, and South Sudan. It is the wrong move, for the same reasons it has always been the wrong move. Travel bans, though a favorite tool of politicians who want to appear as if doing something, impede the flow of personnel and resources intooutbreak zones. Healthcare workers who might volunteer to fight this outbreak will now have to contemplate being corralled by the policy. Other countries follow suit with cascading bans. As such, the International Health Regulations oppose travel bans. They are not evidence-based and objectively harmful. Targeted travel screening is what works. Blanket restrictions have the very real potential to postpone the extinguishing of outbreaks at their source. Critically, the US has 13 NETEC biocontainment treatment centers built precisely for this, and we should be vigilant and proactive without being rattled.
There is also a countermeasure reality to face: there are no approved vaccines or specific treatments for Bundibugyo ebolavirus. The drugs that worked so well in the DRC’s 2018–2020 outbreak are specific to Zaire ebolavirus. They don’t reliably cross-protect against Bundibugyo. BARDA is advancing a monoclonal antibody that targets Ebola Sudan and may have some cross-reactivity (it is likely the treatment that Dr. Stafford has received in Germany), and Oxford and the Serum Institute of India are working on a vaccine using the AstraZeneca COVID platform that might be field-deployable within months.
This countermeasure gap extends to other filoviruses as well. Neither Ebola Sudan nor Marburg, both of which have causes recent outbreaks, have countermeasures as well. These are filoviruses with case fatality rates that routinely exceed 50 percent, and we have had no licensed tools against them. We built countermeasures for Zaire ebolavirus in response to its potential use as a bioweapon and the magnitude of the outbreak 2014. We have not applied the same urgency to the rest of the family, and every outbreak of Sudan virus or Marburg is a reminder of why a viral family approach is desperately needed.
The post-COVID media continually wants to know if this outbreak is “the next COVID” (as they did for hantavirus). The answer is no — Ebola spreads through blood and body fluids, not the respiratory route. Its transmission is constrained. Ebola is a virus that spreads through direct contact with the bodily fluids of the sick and the dead — it finds exactly what it needs in overwhelmed clinics with no PPE and burial traditions that involve touching the body, but the moment it lands somewhere with isolation rooms and infection control, it is quickly stopped in its tracks. They also mention The World Cup. Mass gathering events are perfect venues for crowd diseases such as those caused by a respiratory or gastrointestinal virus — measles, influenza, COVID, norovirus — diseases that spread through the air and via causal contact requiring little more than proximity. Ebola requires you to be in direct contact with someone who is visibly, severely ill and is not a crowd disease.
The real worry isn’t what Bundibugyo will do to the American public. It’s what our hollowed-out response infrastructure will do when the US inevitably faces a true pandemic threat.