Being near the center of an Ebola outbreak means getting used to the smell of chlorine. Hospitals and government buildings spray surfaces with it, and people wash their hands in a 0.05% solution that can kill the virus in 60 seconds. Handheld infrared thermometers check temperatures at airports and border crossings—any sign of fever stops you from passing through. Contact-tracing teams move across the countryside.
From 2018 to 2020, Butembo, in the Democratic Republic of the Congo’s northern Kivu province, was the site of the country’s largest Ebola outbreak. The crisis wasn’t just about the virus itself—it was made worse by the social, political, and economic pressures of a region in the middle of a conflict.
As global health officials deal with a serious new Ebola outbreak in the DRC—one that has surprised the World Health Organization with how fast and far it has spread—the question is: what have we learned from past outbreaks?
Unlike COVID, Ebola isn’t a very efficient virus. It doesn’t spread through the air, so it requires direct contact with bodily fluids like blood or vomit. This makes it especially dangerous for healthcare workers, who need full-body protective gear and strict cleaning procedures.
Social customs, like touching the dead and dying in poor rural communities, helped the virus spread faster in eastern Kivu and Ituri province.
Another major issue that made the response harder six years ago was the political tension between the government in Kinshasa and the Nande ethnic group in eastern Kivu, amid an insurgency. During elections, some cynical actors exploited the outbreak by claiming Ebola didn’t exist or was brought in by outsiders. This led to armed attacks—some deadly—on health workers and Ebola clinics, including one in Butembo while the Guardian was visiting.
A new vaccination program was available during that outbreak, but there’s no vaccine for the current strain in Ituri, which is caused by the Bundibugyo variant of Ebola. This is the least understood of the three forms of the disease, and it has only caused two previous outbreaks—in 2007 and 2012—killing about 30% of those infected.
Another reason for concern in the current outbreak is that cases may have been missed early on, which could have allowed unnoticed transmission.
One key difference from past major outbreaks in west and central Africa is how quickly the WHO has declared this a public health emergency of international concern (PHEIC). In 2018, the WHO was heavily criticized for waiting four months before making that declaration. A PHEIC is defined as “an extraordinary event that may pose a public health risk to other countries through international spread and may require a coordinated international response.”
In the current outbreak, a PHEIC was declared within 48 hours. The WHO’s head, Tedros Adhanom Ghebreyesus, said he was so worried that he decided to act without waiting for an emergency committee meeting.
Despite that, Daniela Manno, a clinical epidemiologist at the London School of Hygiene and Tropical Medicine, has warned that the current Ituri outbreak shares some of the complicating factors of the 2018–2020 outbreak.
“First, the number of suspected cases reported before confirmation suggests the virus may have been spreading for several weeks before the outbreak was officially recognized,” she said. “Second, the outbreak is happening in a region affected by insecurity, displacement, and high population movement—all of which can make surveillance, contact tracing, and healthcare delivery much harder. A previous Ebola outbreak in North Kivu…”Between 2018 and 2020, the outbreak in North Kivu and Ituri provinces lasted nearly two years. Insecurity and community mistrust repeatedly disrupted contact tracing, vaccination, and response efforts.
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A border health officer at a crossing between Uganda and the DRC checks a traveler’s temperature. Experts say the spread into Uganda likely pushed the WHO to act quickly. Photograph: AFP/Getty Images
“In addition, the outbreak is now believed to be caused by the Bundibugyo virus, a rare Ebola-causing virus for which there are currently no licensed vaccines or specific treatments. There are also no vaccines in late-stage clinical development that could be quickly deployed during the outbreak.”
“However, it’s important to note that the DRC has extensive experience in responding to Ebola outbreaks, and its response capacity is much stronger today than it was a decade ago.”
Anne Cori, an associate professor in infectious disease modeling at Imperial College London, said the disease’s spread across an international border likely influenced the quick declaration of a public health emergency of international concern (PHEIC).
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“A PHEIC is an official declaration made by the WHO under international health regulations, recognizing the international nature of a public health threat. It aims to help mobilize attention and resources, and coordinate response efforts at the international level.”
“The last PHEIC for an Ebola outbreak was declared in July 2019 during the 2018–2020 Ebola epidemic in North Kivu province, DRC. At that time, the PHEIC was declared a year into the outbreak, after it reached the urban area of Goma and threatened to spread internationally to nearby Rwanda.”
“The current epidemic already includes confirmed cases in both the DRC and Uganda, which likely influenced the declaration of a PHEIC, as its focus is really on the international nature of the threat.”
Peter Beaumont reported from Butembo for the Guardian in 2019, visiting Ebola treatment centers and vaccination efforts.
Frequently Asked Questions
Here is a list of FAQs based on the topic As the WHO raises the alarm about Ebola in the DRC what lessons can we learn from past outbreaks
BeginnerLevel Questions
1 Why is the WHO raising the alarm about Ebola in the DRC again
The WHO is concerned because the DRC has a history of Ebola outbreaks and new cases can spread quickly in remote areas with weak healthcare systems Raising the alarm early helps get resources and experts on the ground faster to stop the virus
2 What is the biggest lesson we learned from the 20142016 West Africa Ebola outbreak
The biggest lesson is that speed is everything The 2014 outbreak spread because the international response was too slow Now the goal is to declare an outbreak immediately deploy teams and start contact tracing within days not months
3 How does the Ebola vaccine help us now compared to past outbreaks
During past outbreaks there was no approved vaccine Now we have the rVSVZEBOV vaccine which is highly effective against the Zaire strain This allows us to protect frontline workers and the contacts of sick people creating a ring of immunity
4 Why is community trust such a big deal in stopping Ebola
If people dont trust health workersbecause of fear misinformation or past conflictthey hide symptoms refuse treatment and avoid burial teams In past outbreaks this allowed the virus to spread silently Now we know we must work with local leaders and listen to communities
Intermediate Advanced Questions
5 What specific mistakes from the 20182020 North Kivu outbreak are we trying to avoid now
That outbreak was the second deadliest ever Key mistakes included security issues political instability and a lack of community engagement The lesson is that you cannot fight Ebola with just medicine you also need security diplomacy and local trust
6 How has contact tracing improved since the earlier outbreaks
In the past contact tracing was done with paper and pen which was slow and errorprone Now we use digital tools to track contacts in realtime However the core lesson remains you must find
