Congo’s Ebola Outbreak Is Spreading Faster Without a Vaccine to Stop It

The Ebola outbreak tearing through the Democratic Republic of Congo is spreading faster than the response can keep up with, and has become the country’s deadliest ever recorded, and the second-largest in history since 2016. More than 2,000 people have died, and over 4,300 cases have been confirmed across five provinces since the outbreak was declared in mid-May. Only the West Africa epidemic of 2014–2016, which killed more than 11,000 people, has claimed more lives.

Three things have combined to worsen the outbreak. The first is geography and conflict. The outbreak began in Ituri Province, in Congo’s remote and volatile east. In that region, armed groups including the ADF, CODECO and the M23 have fought for years, displacing communities and restricting humanitarian access. Fighting has blocked aid convoys, disrupted contact tracing and made some areas difficult for health teams to reach. Ituri alone accounts for nearly 90% of all cases.

The second is movement. Mining activity draws large numbers of workers in and out of the region, and frequent cross-border travel between Congo and Uganda has helped seed cases beyond Congo’s borders. What started in one health zone, Mongbwalu, has since spread into 49 health zones across five provinces: Ituri, North Kivu, South Kivu, Haut-Uélé, and Tshopo.

The third is trust, or the lack of it. Misinformation about the virus has taken hold in affected communities, and traditional burial practices where families wash and touch the bodies of the dead have continued despite the risk, since Ebola is most contagious around the time of death. Health workers have in some cases been attacked by rebels or frightened crowds, further slowing efforts to isolate cases and trace contacts.

This particular outbreak is not caused by the strain of Ebola that the world has a vaccine for. It is driven by the Bundibugyo virus, a rarer relative of the Zaire strain that the highly effective vaccine was built to fight. For Bundibugyo virus, there is currently no licensed vaccine and no approved treatment anywhere in the world.

The problem is that no vaccine exists yet. The World Health Organization has begun clinical trials of candidate vaccines and treatments, but officials have cautioned it will likely be months before results are known, let alone before any product could be manufactured and distributed at scale. With a case fatality rate hovering around 44%, that leaves supportive care such as fluids, monitoring and treating symptoms as essentially the only tool available, and even that requires functioning clinics and staffed isolation wards.

Congo’s government, working with the WHO and international partners, has set up isolation units, run contact-tracing operations that are currently reaching about three-quarters of known contacts, and coordinated the emergency response through provincial health authorities in Bunia, Ituri’s capital. WHO declared the outbreak a public health emergency of international concern in May, unlocking additional international funding and support. WHO Director-General Tedros Adhanom Ghebreyesus travelled to Congo in early August to press the response effort forward in person.

But the response has been undercut from within. Health workers, including nurses, contact tracers, sanitation teams and burial crews on the front line, say they have not been paid their wages or hazard bonuses since the outbreak began three months ago. In early August, dozens walked off the job in Bunia and staged protests outside the provincial governor’s office, some abandoning treatment facilities altogether.

The result is a response effort that is, by the WHO’s own admission, losing ground. Case numbers are doubling in some hotspots even as international attention and emergency funding increase. Without secure funding for the people actually running the response, and with no vaccine on the horizon for months at best, health workers on the ground say the outbreak is likely to keep outrunning them. Congo’s Ebola epidemic looks set to become the deadliest ever recorded before it is brought under control.