Suspected cases approach 600 as health officials warn outbreak may have gone undetected for months
The World Health Organization (WHO) says the rapidly expanding Ebola outbreak in Central Africa does not currently pose a global pandemic threat, despite a sharp rise in suspected infections and deaths in the Democratic Republic of Congo (DRC) and neighboring Uganda.
Speaking at a news conference in Geneva on May 20, WHO Director-General Tedros Adhanom Ghebreyesus said the outbreak was “not a pandemic emergency,” even as health authorities warned that the true scale of the epidemic may be far larger than official figures suggest.
“The WHO assess the risk of the epidemic as high at the national and regional levels and low at the global level,” Tedros said.
The outbreak, driven by the rare Bundibugyo strain of Ebola, has now reached nearly 600 suspected cases, including more than 130 suspected deaths, according to WHO figures released five days after the outbreak was officially declared.
So far, 51 cases have been confirmed in the Congolese provinces of Ituri and North Kivu. Uganda has also confirmed two cases involving travelers from the DRC, including one death.
“We expect those numbers to keep increasing, given the amount of time the virus was circulating before the outbreak was detected,” Tedros said.
Key Epidemic Metrics & Quick Facts
| Metric / Parameter | Current Status & Details |
| Total Suspected Cases | Nearly 600 individuals (51 laboratory-confirmed) |
| Total Suspected Deaths | 130 fatalities |
| Causative Pathogen | Bundibugyo virus strain (Orthoebolavirus genus) |
| Primary Hotspots | Ituri and North Kivu provinces (DRC); Kampala (Uganda) |
| Vaccine Availability | None licensed; candidates require 2 to 9 months for trials |
| Global Risk Assessment | High at national/regional levels; Low at the global level |
WHO chief concerned over ‘scale and speed’ of Ebola outbreak
WHO chief has expressed concern over the “scale and speed” of an outbreak of a rare type of Ebola known as Bundibugyo in eastern Congo. The Bundibugyo virus has no approved medicines or vaccines.
Last Sunday, Tedros declared the outbreak a Public Health Emergency of International Concern (PHEIC), the WHO’s second-highest alert level. It marked the first time in the organization’s history that such a declaration was made before consulting the International Health Regulations (IHR) Emergency Committee.
Following an emergency meeting on Tuesday, the committee agreed with the designation while concluding that the outbreak did not qualify as a pandemic emergency.
“Our prime aim was to support the decision and decide whether this is a public health emergency of international concern, and to consider whether there’s a pandemic emergency. The former was agreed to,” said Professor Lucille Blumberg, who chaired the committee.
WHO officials said investigations into the outbreak’s origin are ongoing, but early evidence suggests the virus may have been spreading undetected for several months.
“Given the scale, we are thinking that it has started probably a couple of months ago,” said Anaïs Legand, a technical officer for high-threat pathogens at WHO’s health emergencies program.
Officials believe a suspected super-spreader event may have occurred at either a funeral or healthcare facility after the first known death, reported on April 20.
Conflict, Isolation and Delayed Detection
Health authorities say the outbreak’s spread was worsened by armed conflict, weak healthcare infrastructure, and the remote geography of eastern Congo.
The outbreak emerged in Ituri province, where fighting between Congolese forces and the Rwanda-backed M23 armed group has displaced more than 100,000 people in recent months.
“Detecting outbreaks such as Ebola in a complex setting like Ituri province in the DRC is inherently challenging,” said Dr. Mohamed Yakub Janabi, WHO’s regional director for Africa.
“Surveillance systems rely on a combination of community reporting, local health facilities, lab confirmation, and partner coordination,” he added.
The logistical challenges are severe. Samples from the outbreak zone must travel approximately 1,700 kilometers to Kinshasa, home to the country’s only laboratory capable of testing for the Bundibugyo strain.
“In remote or insecure areas, it can take time for cases to be recognised and samples transported,” Janabi said.
WHO officials also said the Bundibugyo strain’s symptoms closely resemble common regional diseases such as malaria and typhoid, contributing to early misdiagnoses.
“Nonspecific early symptoms, for instance, if you take malaria and typhoid, the early symptoms are the same,” Tedros said. “The region is very endemic to those diseases, so the health workers will associate the early signs with malaria or typhoid.”
Dr. Abdi Mahamud, WHO’s director for health emergency alert and response operations, said the diagnostic challenge could have affected even advanced healthcare systems.
“If you don’t have that high index of suspicion, if you don’t have the right facility to test, even in high-income countries, you will have that delay in the start of an outbreak,” he said.
No Approved Vaccine Yet for Bundibugyo Strain
Unlike the more common Zaire strain of Ebola, the Bundibugyo variant currently has no licensed vaccine or approved treatment.
WHO research lead Dr. Vasee Moorthy said several vaccine candidates are under development but are still months away from being available for clinical use.
“There are no doses of this which are currently available for clinical trial, so this needs to be prioritised,” Moorthy said of a promising rVSV Bundibugyo vaccine candidate. “The information that we have is that this is likely to take six to nine months.”
A second vaccine candidate based on the ChAdOx1 platform used in the AstraZeneca COVID-19 vaccine is being developed by Oxford University and the Serum Institute of India.
“It is possible that doses of that could be available for clinical trial in two to three months, but there is a lot of uncertainty about that,” Moorthy said.
In the meantime, WHO officials said the response will focus on traditional containment measures including contact tracing, isolation centers, treatment facilities, and protecting healthcare workers. “The protection of healthcare workers and families is absolutely paramount,” Blumberg said.
Fear and Frustration Grow on the Ground
In eastern Congo, healthcare workers and residents described growing fear as the outbreak accelerates.
“It’s truly sad and painful because we’ve already been through a security crisis, and now Ebola is here too,” said Justin Ndasi, a resident of Bunia, where the first known death was reported.
Residents said masks and disinfectants have become increasingly scarce and expensive as panic spreads.
At treatment centers in Rwampara, healthcare workers in protective suits have begun conducting secure burials while grieving families watch from a distance.
“He told me his heart was hurting, and I thought it was his stomach,” said Botwine Swanze, describing the death of her son. “Then he started crying because of the pain in his stomach. After that, he started vomiting. Then he started bleeding and vomiting a lot.”
At Mongbwalu General Hospital, medical staff warned they are already overwhelmed. “The patients are scattered here and there in rather unusual conditions,” said Dr. Richard Lokudu, the hospital’s medical director. “We hope for the proper triage and isolation facilities to be installed today, and if that doesn’t happen, we will be completely overwhelmed.”
He added that hospital workers remain vulnerable if confirmed infections continue rising. “If confirmed cases surge, we have no protection,” he said.
International Response Intensifies
The outbreak has also drawn growing international attention.
A U.S. national who tested positive for Ebola in Congo was transferred to Berlin on Wednesday and placed in a special isolation ward. German authorities said a “comprehensive examination” was underway to determine treatment options.
Meanwhile, U.S. Secretary of State Marco Rubio criticized the WHO response, saying the organization had been “a little late to identify this thing unfortunately.”
Tedros rejected the criticism, saying the remarks may reflect a “lack of understanding” of the WHO’s role. “We don’t replace the country’s work, we only support them,” he said.
European Union officials emphasized Wednesday that the risk of an Ebola outbreak in Europe remains “very low,” while urging continued vigilance.
“We know that diseases do not stop at the borders, and this is also the case of Ebola,” EU spokesperson Eva Hrncirova said.