Seven days ago, the Ebola outbreak in the Democratic Republic of Congo had 246 suspected cases. On Friday, that number was approaching 750.

The math is straightforward and grim: a tripling in one week, with 177 suspected deaths reported to the World Health Organization.

On Friday the WHO upgraded its risk assessment for the DRC from “high” to “very high” — the most severe designation in its national-level framework. Regional risk remains high. Global risk, the agency says, is still low.

But the virus is moving faster than the response designed to contain it.

“We are running behind, we are not yet under control,” said Dr Anne Ancia, the WHO’s representative in the DRC.

A Virus Without a Vaccine

The outbreak is caused by the Bundibugyo strain of Ebola — a rare species that has caused only two known outbreaks, in Uganda in 2007 and the DRC in 2012. There is no approved vaccine or treatment. The existing Ebola vaccine, successfully deployed against the more common Zaire strain, offers no protection against Bundibugyo, which kills roughly a third of those infected, according to the BBC.

Of the 750 suspected cases, 82 have been laboratory-confirmed, with seven confirmed deaths, according to WHO director-general Dr Tedros Adhanom Ghebreyesus. The much larger suspected figure reflects the difficulty of confirming cases in a conflict-affected region with limited health infrastructure.

Distrust and Fire

On Thursday, the response suffered a concrete setback. A crowd in Rwampara, in Ituri province — the outbreak’s epicentre — set fire to tents and medical supplies outside a hospital where medics were setting up an Ebola treatment centre. The crowd was angry at not being allowed to retrieve the body of a local man who had died there. Ebola patients’ bodies must be buried under strict infection control protocols to prevent further transmission.

Tedros told reporters that “significant distrust of outside authorities among the local population” was hampering operations. Ancia said the Rwampara attack would “significantly jeopardise” the response, though she hoped the facility could be operational again within 24 hours.

A System Weakened Before the Outbreak

The response is also fighting the aftereffects of last year’s international aid cuts. Dr Amadou Bocoum, DRC country director for Care International, said reduced funding meant the “system was not able to work properly because of lack of equipment,” and that lower staff levels made contact tracing — the labour-intensive work of tracking down everyone an infected person has been near — significantly harder.

Julie Drouet, country director for Action Against Hunger, was blunt: “Everyone is working to try to implement as quickly as possible […] the response in the field, however it is not quite yet ready. It is not really yet up to the emergency that we have in Congo at the moment.”

What’s Coming Down the Pipeline

Two tools are in development. Scientists at Oxford University are working on a vaccine using the ChAdOx1 platform — the same technology used for a Covid vaccine. The experimental shot delivers genetic code from the Bundibugyo virus via a modified chimpanzee cold virus, training the immune system without causing infection. The WHO says doses could be available for clinical trials in two to three months, though a spokesman cautioned there is “a lot of uncertainty” and that animal testing, now underway, must first establish it as a “promising candidate research vaccine.” A separate experimental vaccine is six to nine months from readiness.

The WHO’s chief scientist, Sylvie Briand, also pointed to obeldesivir — an experimental oral antiviral originally developed for Covid by Gilead Sciences — as a possible preventive treatment for contacts of Ebola patients, though she stressed it would need to be deployed under “a very, very strict protocol.”

Across Borders

Two cases have been confirmed in Uganda in people who travelled from the DRC, with one death. Tedros said Ugandan measures — including intensive contact tracing and the cancellation of a mass gathering — appeared to have contained spread so far.

A US national working in Congo has tested positive and been transferred to Germany for care. A second American, identified as a high-risk contact, has been transferred to the Czech Republic, Tedros said.

Officials noted one potentially encouraging sign: the rapid rise in suspected cases may partly reflect improved detection, and a slight decline in the proportion of positive test results suggests more symptomatic people are being found. But whether that improved detection can outpace the virus depends on two things currently in critically short supply — resources and trust.

Sources