The Ebola outbreak in the Democratic Republic of the Congo (DRC) has spread to a sixth province, raising fresh concerns among health authorities as the rapidly expanding epidemic threatens to become the deadliest Ebola outbreak ever recorded. The latest development came after a man died in Bas-Uele province following travel from neighbouring Haut-Uele, according to Africa Centres for Disease Control and Prevention (Africa CDC) officials.
The man had travelled from Isiro in Haut-Uele to Buta, the capital of Bas-Uele, where he later died. His death marks the first reported Ebola case in Bas-Uele and has expanded the geographical footprint of the outbreak to six of the DRC’s 26 provinces. Most affected areas are located in the country’s north-eastern region, where insecurity, population movement and weak health infrastructure are making containment particularly difficult.
The scale and speed of the outbreak have alarmed international health agencies. More than 4,500 cases and over 2,100 deaths have been reported in the DRC, according to the latest government figures. The number of deaths has accumulated considerably faster than during the 2014-16 Ebola epidemic in West Africa, which had previously been regarded as the world’s worst Ebola outbreak and eventually claimed more than 11,000 lives. At a comparable stage of that outbreak, only 755 cases had been recorded.
World Health Organization Director-General Tedros Adhanom Ghebreyesus has warned that, if the current trajectory continues, the DRC outbreak could surpass the West African epidemic in terms of deaths. More than 3,400 cases have been detected in Ituri province alone, where the outbreak was initially identified. The situation is further complicated by the fact that between 60% and 70% of newly detected infections are reportedly occurring among people who were not already being monitored as contacts, making conventional contact-tracing efforts increasingly difficult.
The outbreak is being caused by the relatively rare Bundibugyo strain of Ebola virus. Unlike some other Ebola strains, there are currently no approved vaccines or treatments specifically available for Bundibugyo. However, clinical trials of two potential treatments began in Ituri last month, while two vaccines developed for the strain have also entered human testing. Researchers are working urgently to determine how effective these experimental interventions could be in slowing the outbreak.
The health emergency is also unfolding against a backdrop of serious operational challenges. Some healthcare workers have reportedly gone on strike after months without receiving their salaries. Staff at the Nizi treatment centre in Ituri stopped work on Thursday, resulting in the temporary closure of the facility. Health authorities are also facing shortages of international development assistance, threats from armed groups, public mistrust and misinformation about the existence of Ebola itself.
The timing of the outbreak has also raised questions about how long the virus may have been circulating undetected. Although authorities formally declared the outbreak on May 15, genetic sequencing indicates that transmission may have started several months earlier, possibly in February. This suggests that the virus may have spread through communities before health officials were able to identify and respond to the outbreak.
WHO officials have acknowledged the difficulty of keeping pace with the disease. Dr Mohamed Yakub Janabi, WHO’s regional director for Africa, said health authorities were effectively struggling to stay ahead of the virus. Another senior WHO official, Abdirahman Mahamud, said there was still a possibility of turning the situation around within three months if response measures were implemented simultaneously across all major transmission zones. However, even under a moderate scenario, officials expect the outbreak’s peak could take around six months to arrive and that transmission could continue for nine to 12 months.
The virus has also crossed the DRC’s borders. Uganda has reported 20 cases, all in Kampala, although no community transmission has been detected there and the country’s most recent case was reported on June 21. Health officials remain concerned about regional movement because the affected areas have substantial cross-border travel and populations displaced by conflict and economic activity.
Scientists are additionally examining whether the virus itself may be changing. Genetic studies indicate that the strain responsible for the current outbreak differs from Bundibugyo viruses identified during earlier outbreaks in 2007 and 2012. Researchers who analysed virus genomes from 22 patients said the genetic evidence points to a likely animal-to-human transmission event at the beginning of the current outbreak. Africa CDC officials have also raised concerns about possible mutations and are working with WHO on further investigations.
Ebola is transmitted through contact with infected bodily fluids and contaminated materials, including objects associated with infected people. The disease can be severe and frequently fatal, making early detection, isolation, safe care and community cooperation essential to controlling transmission. With the outbreak now extending into a sixth province and many infections occurring outside known contact networks, health authorities face an increasingly urgent race to expand surveillance, restore confidence in the healthcare system and prevent further geographical spread.
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