Update: 2000+ deaths, 4000+ cases; Unknown Chains of Transmission In The Fastest Growing Ebola Outbreak

Newsletter Edition #373 [The Files In-Depth]

Readers,

In this comprehensive edition we bring you updates on the Ebola outbreak from the WHO, Africa CDC and MSF. These were communicated to the press in recent days.

From clinical trials, diagnostics, to financing and implementation; from strategies on contact tracing to active case-finding; from community engagement to challenges of delivery in conflict settings; this edition maps responses from global and regional authorities on this fast moving outbreak as it throws up countless indications for policy measures and legal obligations being discussed in Geneva.

My colleague Shubhangi Thakur has worked on this edition.

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Best.

Priti

Priti Patnaik, Founder & Publisher, Geneva Health Files

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THE FILES BRIEF

Update: 2000+ deaths, 4000+ cases; Unknown Chains of Transmission In The Fastest Growing Ebola Outbreak

By Shubhangi Thakur

Priti Patnaik contributed to this edition

I. WHO PRESS BRIEFING (AUGUST 12, 2026)

1. Scale and trajectory of the outbreak

• The Ebola outbreak in northeastern DRC is the “second-biggest Ebola epidemic on record” and is moving faster than any previous Ebola outbreak; at its current pace, it could surpass the 2014–2016 West African Ebola outbreak.
• 4,449 confirmed cases and 2,061 deaths have been reported across five provinces and 53 health zones
• About 90% of cases and 80% of deaths are in Ituri Province, with sustained transmission in Bunia, Rwampara, Nizi and Lita.
• A high proportion of deaths are occurring in communities rather than treatment units, including among people who were not on known contact lists, pointing to unknown chains of transmission.
• Most transmission is occurring when people with late-stage disease are not in treatment, or through the handling of bodies after death.
• Early clinical care and safe and dignified burials are therefore critical to interrupting transmission.

2. Surveillance, treatment and community response

• Community engagement and community ownership are essential, as early care and safe burials depend on trust among affected communities.
• Surveillance remains the “priority operational challenge”, with efforts focused on strengthening community-based surveillance and bringing suspected cases into care.
• Contact-tracing coverage is currently around 80%, with a target of 95%, considered necessary to interrupt transmission.
• Treatment capacity is being tripled, with a goal of 3,000 beds within 12 weeks.
• The response requires approximately three health workers for every patient, meaning thousands more health workers need to be recruited and trained.
• More than 21,000 community health workers have already been trained.
• Treatment centres, safe burial teams, laboratories and community engagement operations are active across affected provinces and reaching hundreds of thousands of people.
• 886 patients have recovered, despite specific therapeutics and vaccines still being under development and trial.

3. Vaccines and therapeutics

• For the first time, two vaccines specifically designed against Bundibugyo virus have entered Phase 1 safety trials in humans.
• Two new animal studies have shown promising evidence of cross-protection against Bundibugyo virus from the vaccine against Zaire ebolavirus.
• Based on this evidence, the Zaire Ebola vaccine has been recommended for inclusion in a Phase 3 trial, which is intended to begin as soon as possible.
• It is not yet known whether the vaccine is efficacious against Bundibugyo disease in humans.
• The Phase 3 trial is intended to establish whether a safe and effective vaccine can be made available for the current outbreak and future outbreaks.
• The WHO-sponsored PARTNERS trial has reached 100 patients, demonstrating that research can be mobilised “rapidly and responsibly” during an outbreak.

4. Financing, security and the broader response

• The response involves the DRC government, WHO, Africa CDC and other partners, with support from the United States and United Kingdom.
• The major challenge is implementing interventions at the scale and speed required to get ahead of the outbreak, with financing remaining critical.
• Of the US$518 million required for the Continental Preparedness and Response Plan, US$264 million had been disbursed.
• Financing needs to be “timely, impactful and sustainable.”
• Active armed conflict in eastern DRC continues to affect access and the ability of responders to operate safely and effectively.
• The DRC's initial response plan was approximately $240 million for three months; the expanded plan is estimated at approximately $940 million and includes continuity of essential health services.
• The DRC government had already invested approximately $50 million in the response and may increase its contribution, particularly for health professionals working in Ituri.

5. What is driving the outbreak?

• There is currently no evidence that viral mutation explains the scale of the outbreak; studies using available samples are ongoing.
• The current trajectory is better explained by armed conflict, population mobility, difficult conditions on the ground, and social and economic factors that make it harder to break transmission chains.
• The outbreak may have started 2–3 months before the formal declaration. Investigations into the delayed detection include viral sequencing, anthropological studies and investigations into the emergence and spread of the outbreak.
• The response was “behind the curve” from the outset because of the delayed detection.
• Transmission is occurring within households, funerals and healthcare settings, particularly where infection prevention and control measures are inadequate.
• The response must “win over the hearts and minds” of affected communities so they understand transmission, take ownership of the response and communicate openly with health workers.

6. Outlook

• The outbreak is not yet under control, and substantially greater efforts are required across all response pillars.
• The moderate planning scenario is a six-month response horizon, while a worst-case scenario could see the outbreak continue for 9–12 months.
• If all major response components are implemented simultaneously across the five transmission zones, a turnaround within approximately three months could be possible.
• Achieving that turnaround would require stronger community engagement, surveillance, treatment capacity, safe burials, additional human resources, funding and international solidarity.
• The trajectory will depend on implementing the response at the necessary scale; “hope is not a strategy.”

Responses to Questions

1. Phase 3 Ebola Vaccine Trial in the DRC: Design, Vaccines and Participant Selection

Response (Vasee Moorthy, R&D Blueprint WHO)

• The trial protocol remains subject to DRC regulatory and ethics approval, with submission expected shortly.
• The design builds on the Ebola study from the 2014–2015 West African outbreak, but introduces two key changes: Individual randomisation rather than ring randomisation; An adaptive design allowing additional vaccine candidates to be added as evidence emerges.
• WHO, working with Africa CDC, the Institut National de Recherche Biomédicale (INRB) in the DRC and other partners, convened leading clinical trial design experts, including representatives from sub-Saharan Africa, to update the previous protocol.
• A 31 July TAG report highlighted emerging animal evidence supporting Ervebo as the first active vaccine arm.
• Oxford (with the Serum Institute of India manufacturing) and Moderna are expected to share their Phase 1 results in September. Their Bundibugyo-specific vaccine candidates could be incorporated into the adaptive trial if the results support their use.
• Subject to approval, the trial will enroll contacts of newly identified Ebola cases. Following community engagement, eligible contacts who provide consent will be individually randomised.

2. Delayed Ebola Detection and Community Adherence to Response Measures

Combined Response

(Chikwe Ihekweazu, Executive Director, WHO Health Emergencies Programme)

• The outbreak had started several months before it was formally detected and confirmed. Investigations are ongoing into the reasons for the delay, including viral sequencing, anthropological studies and investigations into the emergence and spread of the outbreak. It is not yet possible to establish exactly when the outbreak began, although current estimates suggest it may have started 2–3 months before the formal declaration.
• The response was “behind the curve” from the outset because of the delayed detection, compounded by the difficult humanitarian and socioeconomic conditions in eastern DRC.
• Outbreak response takes place while normal life and socioeconomic activities continue, meaning protocols cannot simply be imposed on communities. The response needs to “win over the hearts and minds” of affected communities by ensuring they understand transmission, participate in the response and communicate openly with health workers.
• Transmission risks are particularly significant within families caring for sick relatives and during funerals, where established cultural and social practices can unintentionally facilitate transmission. Some progress has been made, but the outbreak remains not yet under control, making community ownership central to the response.

(Thierno Baldé, Ebola Incident Manager, WHO)

• The response is working with community leaders, women’s associations and other local leaders to put communities at the centre of the response. Communities are being encouraged to identify their own needs and help shape the response, rather than having interventions imposed on them.
• Behaviour change will not happen in one day; it is a process requiring sustained engagement. Community involvement is already contributing to surveillance, with suspected cases being reported by communities and community leaders.
• Strengthening community engagement alongside greater operational capacity remains an urgent priority.

3. Ebola Outbreak Declaration Criteria, Uganda and Security in the DRC

Response (Chikwe Ihekweazu)

• There are no current plans to change the existing criteria for declaring an Ebola or Marburg outbreak over. The standard remains two full incubation periods without evidence of local transmission — 42 days for Ebola and Marburg, based on a 21-day incubation period.
• In Uganda, the 42-day countdown followed the last case of local transmission, but an imported case was subsequently detected.
• Uganda therefore remains under heightened surveillance following the imported case, with the relevant follow-up period determined from that case.
• Because Uganda borders the DRC, where transmission continues, intensive surveillance must be maintained in Uganda.Uganda has demonstrated strong capacity to detect and respond to imported cases.
• Continued transmission in the DRC means Uganda needs to maintain surveillance and preparedness at a high level of intensity.

4. Interpreting the 80% Contact-Tracing Figure

Response (Thierno Baldé)

• The outbreak spans five provinces, with substantial variation in transmission patterns between locations. In central Ituri, including Bunia and surrounding areas, transmission remains particularly high, and the cases being detected may represent only part of the actual outbreak. Not all cases are currently being identified. In lower-transmission areas such as Aru near the Ugandan border, contact tracing can reach more than 80%. In one recent case, 100% contact follow-up was achieved, with three weeks passing without a secondary case.
• The response is being adapted to local transmission patterns. High-transmission areas are prioritising safe and dignified burials, isolation and treatment, case investigation and contact tracing.

5. Timing of the Outbreak Peak and Conditions for Turning the Trajectory Around

Response (Abdirahman Mahmoud, Director, Health Emergency Alert and Response Operations)

• The outbreak is not homogeneous, with different areas following different trajectories. In central Ituri, including Bunia and surrounding areas, transmission has not yet reached its peak. In areas where transmission began earlier, such as Mangina, cases are declining and treatment-bed occupancy is around 20–30%. Unless the Bunia and Greater Bunia hotspot is brought under control, continued waves of transmission are expected.
• The current planning scenario is a six-month response horizon, while a worst-case scenario could see the outbreak continue for 9–12 months.
• A turnaround within approximately three months could be possible if all major response components are implemented simultaneously across the five transmission zones
• This would require stronger community engagement, surveillance, treatment capacity, safe and dignified burials, human resources, funding and international solidarity.
• Mahmoud noted that it took approximately 3.5 months to increase treatment capacity to around 1,000 beds, underscoring the scale of investment required to reach 3,000 beds. He stressed that “hope is not a strategy” and that the trajectory depends on implementing the response at the necessary scale.

6. Viral Mutation, Outbreak Drivers and Financing the Ebola Response

Combined Response

(Sylvie Briand, WHO Chief Scientist; Dr. Abdirahman Mahmoud)

• Studies using available samples are ongoing, but there is currently no evidence that mutations explain the scale of the outbreak.
• All viruses undergo mutation, but the current trajectory is better explained by the context in which the virus is circulating, including armed conflict, population mobility, difficult conditions on the ground, and social and economic factors that make transmission harder to interrupt.
• The larger concern remains continued transmission alongside insufficient response capacity and resources.

(Chikwe Ihekweazu)

• Approximately 50–60% of the overall response plan was funded at the time of the briefing. With the outbreak continuing, the response now needs to be significantly intensified, potentially reaching two to three times the current scale.
• Two immediate priorities are: ensuring existing financial pledges are fulfilled; securing additional resources to bring the outbreak under control.

(Anne Ancia, WHO Representative in the DRC)

• The initial DRC response plan covered three months and was budgeted at approximately $240 million. A new plan, reflecting the worsening situation and longer-term needs, is estimated at approximately $940 million and includes continuity of essential health services, not just Ebola activities.
• Communities are also facing deaths from other causes, including diarrhoeal disease, acute respiratory infections and maternal deaths linked to inadequate access to water, blood and emergency obstetric care.
• Response funding is largely being channelled through international and implementing partners, including WHO, UNICEF, UNHCR, UNFPA, Africa CDC, MSF, International Medical Corps, ALIMA and other NGOs.
• The DRC government has raised concerns about receiving relatively little direct financing. Discussions are underway to increase direct government financing, including for health professionals involved in the response.
• The DRC government has already invested approximately $50 million and may increase its contribution, particularly for health professionals working in Ituri.

(Thierno Baldé, Ebola Incident Manager)

• The outbreak’s trajectory is being shaped not only by the virus itself but also by the fragile health system and limited access to blood, medicines and primary healthcare. Addressing these wider health needs is also important for community trust and acceptance of the Ebola response.
• The broader objective is for communities to see responders as supporting their overall health and wellbeing, rather than focusing exclusively on Ebola.

7. U.S. Ebola Funding, Community Responsibility and Government Leadership

Response (Chikwe Ihekweazu)

• WHO welcomed the $242 million U.S. contribution, but explained that U.S. funds are disbursed through the country’s own mechanisms to implementing organisations. As the funds do not flow through WHO, WHO could not comment on their specific distribution or use.
• WHO rejected the idea that it was blaming communities for the outbreak. Transmission is shaped by multiple factors, including the virus, communities, the humanitarian and socioeconomic context, the health system and the wider response environment.
• Community engagement is essential because transmission occurs within households, funerals and healthcare settings, particularly where infection prevention and control measures are inadequate.
• The objective is for communities to “own the response”, rather than simply comply with externally imposed measures. WHO has seen increasing engagement from community, religious, women’s and youth leaders.
• At the same time, WHO stressed that the DRC government must own and lead the national response. External organisations cannot independently lead a national outbreak response. The response therefore requires government, communities, WHO and other partners to work together toward the same objectives. 

II. AFRICA CDC BRIEFING (AUGUST 13TH & 6TH)