The Ebola Bundibugyo virus outbreak is showing initial signs of containment in the Ituri province of northeastern Democratic Republic of Congo – where it first surfaced in April. 

But in North Kivu province, to the south, the cases are still rising fast – with the number  of weekly cases nearly doubled over the past two weeks, from about 100 to 200 cases. 

Elsewhere, there are mixed signals, which make it difficult to define a single trend, said WHO Director General Dr Tedros Adhanom Ghebreyesus and other senior WHO staff at a Geneva press conference on Wednesday. 

To date,  more than 7200 cases have been reported, and over 3500 deaths across seven DRC provinces. “Although there are signs of reduced transmission in Ituri, it’s reducing from a high level in the past week alone, around 300 new cases and 160 deaths were reported, accounting for nearly half the national total,” Tedros said.   WHO declared the outbreak a Public Health Emergency of International Concern in May. 

With regards to trends elsewhere, “the area is so vast that it’s hard to speak of a single epidemic,” Tedros noted, referring to DRC’s span, a country the size of western Europe. “It’s many outbreaks in many places. We must get the response right in every one of them. 

“There are major cities such as Kisangani, home to 1.5 million people, and remote villages. There are conflict-affected areas, mining zones, and sparsely populated lands near the border with South Sudan in a region of very high population mobility. 

“In many areas, roads are barely passable and reaching people by small aircraft is often hard. And while most Congolese people support the response, a small minority have attacked aid workers and health facilities.”

Urges approval of UN draft declaration on pandemics before the General Assembly 

Tedros urged WHO and UN member states to approve a draft resolution on Pandemic Prevention, Preparedness and Response, due to be considered at a High Level Meeting of the UN General Assembly on 25 September, saying that the declaration could help move the world from the kind of ‘ad hoc’ actions that have been a feature of the Ebola response to more coherent measures.  

“The world remains insufficiently prepared,” the WHO head declared. “In the draft declaration, countries are committing to expand research and geographically diversified production, so vaccines, diagnostics, and treatments can be available, affordable, and accessible within the first 100 days of a pandemic threat.

“The draft declaration also calls for a one-health approach, inclusive community engagement, action against misinformation, stronger implementation of the [WHO] International Health Regulations,” Tedros added, referring to the rules that require countries to inform WHO promptly about any outbreak posing an epidemic risk, and coordinate its response.”

And it calls for timely completion of the Pathogen Access and Benefit-sharing (PABS) annex to the WHO pandemic agreement – “which member states are negotiating here in Geneva as we speak,” he said. “It’s essential that countries finalize negotiations so the Pandemic Agreement can begin the ratification process and enter into force.” See related story here: 

‘Critical’ to Complete Pandemic Agreement by UN Meeting in 2026

In Ebola response, humanitarian crisis shadows outbreak challenges 

The deep humanitarian crisis facing DRC continues to confound response to the Ebola outbreak in multiple dimensions, the WHO officials underlined.  The crisis is the result of years of fighting between the powerful, Rwanda-backed M-23 militia, and government forces, leading to mass displacement and loss of livelihoods.  The conflict’s resurgance in late 2024 and January 2025 made things even worse. The M-23 forces took over large chunks of eastern Congo, including the regional capital of Goma, forcing a new wave of displacement from homes and farms.  

“Nearly a million people in Ituri alone are living in refugee camps, and then, together with that, there is hunger,” observed Tedros. 

Amidst the rise in hunger, and threats of insurgent forces, people are less likely to turn to health clinics, leading to more maternal and newborn deaths, as well as illness and death from other treatable conditions, like HIV, the WHO DG pointed out. 

The conflict has also led to simmering resentment in DRC which has seen a massive response to the Ebola outbreak – while deeper, underlying problems are left to fester. 

Against that landscape, local communities have sometimes resented the visibly massive deployment of healthworkers – seeing it as a reflection more of cynical self-interest by western donors fearful of the virus’s international spread, rather than an effort to save local lives. 

Those attitudes are changing in light of the deadly toll the virus has taken – but ever so slowly, Tedros observed: “Ebola is seen as a more serious, but lesser evil still” in comparison to issues like the loss of livelihoods.”  

Humanitarian groups have asked donors for some $1.1 billion to address the deeper roots of the DRC’s crisis, noted Chikwe Ihekweazu, Executive Director, WHO Health Emergencies Programme. 

That is along with a request for some $1.3 billion from donors for the Ebola response, as such. Ihekweazu declined to say how much of those funds had actually been raised. 

Vaccine and therapeutic trials

Along with improved case reporting and contact tracing, at least in Ituri province, the past several weeks has seen the initial rollout of the ERVEBO Ebola vaccine among health workers. 

The vaccine, approved for the Zaire Ebolavirus strain, is being administered in the context of observational trials to see if it also offers protection against Bundibugyo, for which no vaccine yet exists, said WHO’s Meg Doherty, director of the Department of Science for Health, at the press briefing.

“Already, in Kisangani more than 3,000 or so persons have been vaccinated,” Doherty said at the briefing, adding that soon, Médecins Sans Frontières (MSF) is planning to launch a much larger study, involving some 20,000 frontline health workers, “that will look at the vaccine’s impact on Bundibugyo disease, morbidity, mortality.” Kisangani is the capital of DRC’s Tshopo province, just to the west of the hotspots in Ituri province. 

In parallel, a laboratory study of blood samples drawn from people who received the ERVEBO vaccine should also get underway in the coming two or three weeks, she said, led by the University of Antwerp and the DRC’s Institut National de Recherche Biomédicale (INRB). The study will attempt to determine if the antibodies generated against the Zaire Ebola strain can also provide cross-protection against the Bundibugyo virus strain. 

“And then after that we will be bringing in sequentially other vaccines that are specific for Bundibugyo and those are the ChAdOx1 and the Moderna vaccines that you’ve heard much about,” Doherty said. 

The ChAdOx1 vaccine candidate is being developed by the Oxford Vaccine Group in partnership with the Serum Institute of India, and is in Phase 1 trials. It utilizes the same adenovirus platform that underpinned the Oxford/AstraZeneca COVID-19 vaccine, adapted to target a Bundibugyo virus protein. 

Moderna’s mRNA-1469 vaccine candidate uses mRNA technology deployed in the COVID pandemic to teach host cells to identify and target a Bundibugyo surface glycoprotein. Phase 1 trials of that vaccine were initiated in August in Canada, supported by funding from the Coalition for Epidemic Preparedness Innovations (CEPI).

In terms of deployment of the vaccine candidates in DRC field trials, Doughtery did not provide a timeline.   

Image Credits: X/Tedros Adhanom Ghebreyesus, X/@DrTedros, DRC Health Ministry.