The Democratic Republic of the Congo’s Ebola outbreak is the fastest-growing on record, Africa CDC told its weekly briefing on Wednesday, with confirmed cases up 25% over the past week to 1,759 and deaths reaching 600.

The outbreak’s reproductive number is 1.4, meaning every 10 infections lead to roughly 14 more, while the case fatality rate is 34%, officials said. At Africa CDC’s previous press conference a week earlier, on 30 June, the toll stood at 1,406 cases and 438 deaths.

“The virus is still ahead of our response,” said Wessam Mankoula, who heads the continental Incident Management Support Team coordinating the response for Africa CDC and the World Health Organization (WHO). “However, the window of opportunity is still open.”

The WHO declared the outbreak, caused by the Bundibugyo strain, a public health emergency of international concern on 17 May. No licensed vaccine or treatment exists for the strain, while a therapeutics trial began at an undisclosed site in Ituri, Africa CDC said last week.

“We need to go ahead of the virus,” Mankoula said. “And to go ahead of the virus, we need more resources.”

An economic emergency beyond health

A UN Development Programme assessment released this week warned the outbreak could push 985,000 more people into poverty and cost African economies up to $3.6 billion if regional and global shocks intensify.

Even if the virus is contained in the DRC and Uganda, UNDP projects DRC losses above $1 billion in GDP and 55,000 jobs. The poorest fifth of households face a 1.76% drop in daily consumption, “a loss that erases fragile development gains and threatens to create a long-term poverty crisis,” UNDP said.

“The results tell a clear story about the Africa-wide development cost of the outbreak. Even without widespread transmission, the economic consequences of the Ebola outbreak extend well beyond the epicentre, affecting output, employment, investment, and household welfare across the continent,” the analysis found. “When compounded by global shocks, these pressures intensify and spread further… In all scenarios, the burden falls disproportionately on the most vulnerable households

Women, who dominate informal cross-border trade and the frontline care workforce responding to the outbreak, carry the heaviest burden and “heightened risk” of direct exposure to the Ebola virus, the report said.

“Ebola does not stop at the hospital gate. It affects livelihoods, education, food security, trade, public finances and trust,” said Ahunna Eziakonwa, UNDP’s regional director for Africa. “If we treat this Ebola outbreak solely as a health challenge, we risk missing the much larger development emergency unfolding around it.”

Diverted health services could also cause up to 2,520 excess infant deaths from non-Ebola causes, the report found.

The outbreak “signals a complex development emergency in the sub-region, one that cannot be addressed by exclusively focusing on the health sector,” the report said.

Spread and surveillance

The outbreak spans three provinces and 37 health zones in the DRC, with 94% of cases in Ituri. Six zones have reported no confirmed cases in 21 days. Women account for 53% of infections, most among people aged 15 to 44.

Treatment capacity has nearly doubled to about 800 beds from 460 two weeks ago, but occupancy holds near 95%, and tops 137% in North Kivu.

“Urgently, we need to increase bed capacity by at least 50% immediately to isolate those cases,” Mankoula said. “Any delay in the isolation of suspected and confirmed cases contributes to the spread of the disease.”

The highest fatality rates are in North Kivu, where insecurity blocks responders: 51% in Katwa and 43% in Beni. “Because of security challenges, we are not able to surge our response capacity in North Kivu,” Mankoula said.

Just 32% of new cases come from known contact lists, against a 90% target, and each case is linked to only seven contacts. More than half of cases are flagged only after 72 hours of symptoms. “While progress has been made, key bottlenecks persist, including access to workforce, which currently challenges contact tracing and case investigation efforts,” Africa CDC said, adding that it is deploying 4,000 community health workers as part of a 20,000-strong target with WHO and UNICEF to shore up contact tracing.

Uganda, by contrast, has all but contained its outbreak: 17 of 20 cases have recovered, one remains in hospital, and contact tracing is complete, officials said. “Uganda is still demonstrating that Ebola can be controlled,” Mankoula said.

Workers strike as dangers mount

Frontline Ebola responders in Ituri walked off the job this week over unpaid wages. Surveillance teams, security staff, community mobilisers and burial teams are among those striking, demanding pay owed since the outbreak was declared on 15 May, according to the Associated Press.

Mankoula said Africa CDC was in touch with the government to fast-track payments, while urging development partners who had pledged to financially assist the response to speed up disbursement. Around 21% of a pledged $1 billion has been disbursed, Mankoula said. The Ebola response needs $518 million, and the wider humanitarian bill exceeds $800 million.

“We are urging all partners and donors to fast-track the disbursement of those resources quickly,” he said. “We need a decent work environment for our frontline healthcare workers who are fighting this growing Ebola outbreak.”

The agency has released $2 million to the DRC, some of which can cover the delayed payments, he added.

Attack on Ebola Hospital in Eastern Congo Echoes Past Violence Against Health Workers

As checks fail to clear, the dangers to medical responders are also growing increasingly deadly. In the current outbreak, 112 health workers have been infected, and 35 have died from exposure to the virus, as health staff risk their lives without pay, frustrating the workforce.

Ebola responses in eastern DRC carry a violent history. At least 25 health workers were killed, and more than 450 acts of violence or threats against them were recorded during the 2018-2020 Kivu epidemic, when 171 health workers also contracted the virus. Shades of that violence have resurfaced in recent weeks, as civilians set fire to Ebola treatment camps across Kivu province.

Mankoula said misinformation continues to drive attacks on responders, as communities continue to doubt the very existence of Ebola and resist safe-burial practices, which require the difficult step of separating a family from their loved one when they pass away, due to the virus remaining contagious after people pass away. The extent of the mistrust is deep, with one Lancet study

A Lancet Infectious Diseases study conducted in Beni and Butembo following the 2018 outbreak found that one in four respondents believed the Ebola outbreak was not real, and that such beliefs were strongly associated with a “decreased likelihood of adopting preventive behaviours, including acceptance of Ebola vaccines.”

“We need more community health workers deployed urgently, and we need to keep protecting our healthcare workers by spreading accurate information, not contributing to misinformation and disinformation, and by making personal protective equipment available to avoid infection,” Mankoula said.