The recurring Ebola virus disease outbreaks in Africa: the problem is not outbreak response, but failure to sustain preparedness between epidemics

The persistence of Ebola virus disease (EVD) outbreaks in Africa does not reflect an absence of knowledge about containment; rather, it reflects repeated failure to sustain preparedness between epidemics. The ongoing EVD outbreak in the Democratic Republic of the Congo (DRC) and Uganda, highlights critical gaps in preparedness despite substantial investments in outbreak response capacity since the 2014–2016 West African epidemic. The 2026 EVD outbreak is caused by Bundibugyo virus (Orthoebolavirus bundibugyoense), an Ebolavirus species for which there is currently no licensed vaccine or approved therapeutic.¹ As of 14 June 2026, the DRC had reported 808 confirmed Bundibugyo virus disease (BVD) cases, including 192 confirmed deaths (24% case fatality rate [CFR]), while Uganda had reported 19 confirmed cases and two deaths (11% CFR) as of 14 June 2026.² The outbreak was declared a Public Health Emergency of International Concern (PHEIC) by the World Health Organization (WHO) on 17 May 2026 to facilitate a coordinated response.³ While response efforts have been rapidly mobilized, transmission may have begun several months before the outbreak was officially recognized,⁴ highlighting the importance of effective surveillance and early warning systems for timely EVD outbreak detection.⁵

Community-based surveillance remains a persistent weakness in EVD preparedness across many African settings.⁶ The apparent delay between the onset of transmission and recognition of the current BVD outbreak highlights the consequences of surveillance systems that continue to rely heavily on facility-based detection methods. EVD outbreaks frequently occur in settings where access to healthcare services, laboratory diagnostics, and surveillance capacity are limited,⁷ including conflicted-settings. Delayed recognition of unusual illnesses at community level allows transmission chains to become established before public health authorities are alerted. During the 2015 EVD outbreak in Sierra Leone, community event-based surveillance identified cases without known epidemiologic links and detected some of them more rapidly than the national surveillance system.⁸ Yet, many community-based surveillance initiatives are not sustained once outbreaks end, leaving countries vulnerable to the same detection failures during subsequent epidemics.

The failure to sustain pandemic preparedness also extends beyond surveillance systems. Community trust is often rebuilt during outbreaks and neglected once they end, allowing distrust, misinformation, stigma, and fears surrounding isolation or burial practices to re-emerge during subsequent epidemics. Community engagement should be sustained between outbreaks rather than activated only during emergencies.

The current BVD outbreak also highlights how preparedness efforts often remain focused on the last epidemic rather than the next one. Four Ebola virus species are known to cause human disease including Zaire, Sudan, Bundibugyo, and Taï Forest ebolaviruses.⁹ However, most licensed vaccines and therapeutics target Zaire ebolavirus.⁹ Therefore, preparedness should move beyond species-specific approaches and prioritize vaccine and therapeutic platforms that can be rapidly adapted to other Ebola virus species.

Another recurring weakness is the fragility of cross-border epidemic governance systems. Cross-border movement of people for economic activities can facilitate the geographic spread of EVD outbreaks.¹⁰ However, surveillance systems, case investigation processes, data-sharing mechanisms, and response structures are often organized within national rather than regional boundaries. Consequently, outbreaks that span multiple countries may be more difficult to detect and contain. Regional coordination should be a core component of Ebola preparedness.

Finally, Ebola preparedness remains heavily dependent on emergency financing mechanisms activated only after an outbreak is declared. This cycle of reactive funding leads to a gradual loss of capacity developed during emergencies once outbreaks subside. Surveillance systems weaken, trained personnel are redeployed, stockpiles diminish, and preparedness plans become outdated. The challenge is not the absence of technical knowledge but the failure to institutionalize and finance preparedness as a permanent public health function in the country.

Moving forward, the priority should not be to create new preparedness frameworks but to implement and sustain existing ones. Africa's Health Security and Sovereignty agenda (AHSS) provides an important foundation through its emphasis on resilient public health institutions, workforce development, Africa-based manufacturing, strategic partnerships, and sustainable domestic financing.¹¹ Building on these principles, we propose a roadmap for action (Fig. 1) framed not as a new framework but as a means of operationalising existing commitments such as AHSS that prioritizes maintaining preparedness capacities between outbreaks. The current BVD outbreak provides an opportunity not only to strengthen preparedness systems, but also to ensure that these investments are sustained after transmission is interrupted. Until preparedness is treated as a continuous investment rather than an emergency response activity, Africa will remain vulnerable to repeated cycles of delayed detection, uncontrolled transmission, and reactive outbreak response.

Fig. 1.

A roadmap for action to strengthen Ebola preparedness and prevent recurrent outbreaks in Africa. Continuous investment in preparedness, grounded in communities and science would help prevent the next Ebola outbreak.

Contributors

Chidozie Declan Iwu, Chinwe Iwu-Jaja, Sean Mark Patrick and Charles Shey Wiysonge contributed to the study conception, manuscript drafting, and critical revision of the work.

Declaration of interests

Authors declare no conflict of interest.