They say the WHO’s emergency declaration reflects fears that the vaccine-resistant Bundibugyo Ebola strain could spread further through fragile health systems in central Africa.
Australian infectious diseases experts say the WHO’s declaration of a global Ebola emergency is a stark reminder that emerging outbreaks can rapidly overwhelm fragile health systems, particularly when no vaccines or treatments are available.
The World Health Organization has declared the Ebola outbreak in the Democratic Republic of the Congo (DRC) and Uganda a public health emergency of international concern (PHEIC).
The move has triggered international mobilisation efforts as cases linked to the rare Bundibugyo strain continue to spread through conflict-affected regions and urban centres.
Australian experts said the declaration reflected growing concern over the scale of undetected transmission, healthcare worker infections and the absence of approved vaccines or therapeutics for the Bundibugyo ebolavirus.
Curtin University Professor of International Health Jaya Dantas lived in Uganda and Rwanda in the mid to late 90s when there was an outbreak there and has seen firsthand how the virus impacts not only people, but communities.
Professor Dantas said outbreaks like this show the importance of early detection, public health preparedness and international collaboration.
“This outbreak is concerning not only because Ebola has reached major urban centres, but because it’s occurring in a region already facing conflict, displacement and strained healthcare systems,” he said.
“The world learned during covid that infectious diseases do not respect borders. Rapid detection, surveillance, international coordination and public trust are critical to containing outbreaks before they escalate.
“There are also broader concerns about whether global outbreak response capacity is being weakened at a time when emerging infectious diseases are becoming more frequent.
WHO Director-General Tedros Adhanom Ghebreyesus made the emergency declaration after confirmed cases emerged in both DRC and Uganda, including infections in Kampala and one death linked to cross-border travel.
The WHO said 51 cases had been confirmed in DRC, primarily in Ituri and North Kivu provinces, but warned the true outbreak was likely much larger, with nearly 600 suspected cases and 139 suspected deaths under investigation.
The outbreak has also infected healthcare workers, raising fears of healthcare-associated transmission in already overstretched systems.
Professor Paul Griffin, director of Infectious Diseases at Mater Health Services and the head of the Mater Clinical Unit for the University of Queensland School of Medicine, said the declaration was justified given the combination of cross-border spread, healthcare worker infections and uncertainty about the outbreak’s full extent.
“The current situation with Ebola, caused by the Bundibugyo strain of ebolavirus predominantly in the Democratic Republic of Congo, is certainly one that warrants careful attention and makes the declaration of a public health emergency of international concern very reasonable. However there are important points of clarification,” he said.
“Firstly, a public health emergency of international concern is not at all related to there being concern of pandemic potential. Ebola is not a new virus, discovered in the late 1970s and requires close contact or contact with blood or body fluid to be transmitted.”
He noted that the mortality rate from Ebola was much greater than that of respiratory viruses such as covid, with the mortality of the Bundibugyo strain often quoted as between 25 to 50%.
“While this is bad for those infected and makes the current situation very significant, it does mean cases are more likely to be displaying significant symptoms and therefore be identified and ideally managed accordingly to limit onward spread,” Professor Griffin said.
“Provided, of course, that there are appropriate resources to do so, which hopefully the declaration of the PHEIC will help ensure is the case.
“Concerning elements of the current situation include the high numbers of suspected cases and deaths have already been reported at approximately 250 to 300 and at least 88, respectively. It is thought, however, that the true numbers may already be far greater.
“While there are vaccines for Ebola, unfortunately, these are for a different strain, namely, for Zaire ebolavirus. This means there are no vaccines or treatments for the Bundibugyo strain.”
Dr Joanne Macdonald, associate professor of Molecular Engineering and Science Discipline Lead at the University of the Sunshine Coast, said Bundibugyo had historically caused only small outbreaks and had not previously been linked to major multi-country epidemics.
“So this outbreak is unusual: it involves a strain that is both less studied and not covered by current vaccines, but is now causing a larger event than typically seen for Bundibugyo. Without a targeted vaccine, controlling its spread is likely to be more challenging.”
Molecular virologist Associate Professor Vinod Balasubramaniam, leader of the Infection and Immunity Research Strength at the Jeffrey Cheah School of Medicine and Health Sciences at Monash University in Malaysia, said the WHO declaration should not cause panic because Ebola transmission still required direct contact with infected bodily fluids rather than airborne spread.
“This is not about border closures or fear,” he said.
“It is about supporting affected countries quickly and using evidence-based public health before the outbreak becomes harder to contain.”
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Professor Adrian Esterman, chair of Biostatistics at Adelaide University, said the appearance of two apparently unrelated cases in Kampala suggested the outbreak in DRC was likely broader than surveillance systems currently detected.
“At least four healthcare workers have died from Ebola virus,” he said.
“Previous Ebola epidemics have shown how easily health facilities can become major sites of transmission.
“The main problem is understaffed and under-resourced frontline care, combined with delayed presentation through informal clinics, pharmacies and traditional healers outside the formal health system.”
Research into vaccines for Bundibugyo also remained in pre-clinical stages, Professor Esterman noted.
“There is ongoing work on a pan-filo virus vaccine that could potentially have applications for Bundibugyo, but clinical-stage candidates do not yet exist,” he said.
“This underscores why preparedness planning and regulatory groundwork are essential now.”
The WHO said the outbreak did not meet the threshold for a “pandemic emergency”, the newer and higher alert category introduced under the amended International Health Regulations following the covid pandemic.
Associate Professor Jonathan Liberman, a Global Health Law advisor at the Burnet Institute and Associate Professor in Law and Global Health in Melbourne Law School at the University of Melbourne, said the PHEIC declaration still carried significant legal and operational weight because it enabled WHO to coordinate international recommendations and response measures.
The agency has already deployed personnel, supplies and emergency funding to support response efforts in DRC and Uganda, while Uganda has postponed its annual Martyrs’ Day celebrations, which can attract up to two million people.
Experts said the outbreak underscored the importance of maintaining investment in diagnostics, surveillance and preparedness between crises.
Professor Kirsten Spann, associate dean of research in the Faculty of Health at the Queensland University of Technology’s School of Biomedical Science, said rapid deployment of Bundibugyo-specific diagnostics across the region was now critical to identifying mild cases and reducing transmission.
“This outbreak is an example of the importance of maintaining global diagnostic capabilities, including public health units that can deliver diagnostics, and also utilising technology to ensure rapid design and production of tests,” she said.
“Globally, funding for diagnostic development is limited between outbreaks of disease, but then we are reminded each time situations like this arise that we need consistent efforts and funding for diagnostic development so that we can be prepared.”
