On Aug. 20, in Bulape, a small town in the Democratic Republic of Congo’s Kasaï province, a 34-year-old pregnant woman was admitted to the local hospital with sudden fever, bloody vomiting, and profound weakness. Despite supportive care, her condition rapidly deteriorated, and five days later, she died.
Her death was not just a personal tragedy. Laboratory testing confirmed she had Ebola. By the time the government declared the Ebola outbreak on Sept. 4, there were already 28 suspected or confirmed cases and 15 deaths — more than 50% fatal, including four health care workers.
By Sept. 6, 42 suspected cases had been reported, including five confirmed and 15 fatalities for a death rate of 38%. At the same time, containment efforts have been hindered by weak surveillance: Of the 157 identified contacts, only 19% are being monitored, raising serious concerns about the potential for further spread.
Within 24 hours of the outbreak declaration, scientists in the DRC released the virus’s genomic sequence — a remarkable milestone. Their analysis showed the strain was 99.5% similar to the Ebola virus first identified in Yambuku, Mongala province, in 1976. (The virus is named for the Ebola River, which flows through Mongala.) Yet the virus in the new DRC outbreak is distinct from the one that spread during the Kasaï province outbreaks in 2007 and 2009. This finding suggests that the outbreak stems from a new spillover event from nature rather than lingering transmission. The speed and transparency of this analysis are extraordinary — and potentially lifesaving.
For Kasaï, this outbreak is terrifying but not without precedent. The DRC has faced Ebola 15 times before, often in communities served by health systems with scarce beds, limited oxygen and medicines, and often without even running water.
Distance should never be mistaken for irrelevance. The 2014-2016 West Africa Ebola outbreak began in a rural Guinean village and ended with more than 28,000 cases, 11,000 deaths, and $53 billion in losses, with patients treated as far away as the United Kingdom, Spain, and the United States.
Kasaï is remote, with outbreaks usually contained locally. What makes this different is not Ebola itself, but the moment in which it has emerged. A decade ago, the United States would have been at the center of the response — financing rapid diagnostics, dispatching teams of epidemiologists, airlifting medical countermeasures, and working alongside regional and country partners. That scaffolding of support meant outbreaks were often caught early and extinguished before they spiraled.
Today, that scaffolding is unraveling at the moment it is most needed. The U.S. Agency for International Development — once the largest health funder in the world — has been dismantled. A recent Lancet study projected its absence could lead to 14 million preventable deaths by 2030, including 4.5 million children. PEPFAR, credited with saving 25 million lives from HIV and AIDS, is being gutted, a move that risks reversing decades of progress and fueling new waves of infection. In the United States, the Centers for Disease Control and Prevention and the Department of Health and Human Services have been reorganized, with vaccine advisory boards sidelined, weakening the very expertise needed in moments of crisis. In Geneva, the U.S. has begun formal withdrawal from WHO, severing ties with one of the key partners working to contain the Ebola outbreak in Kasaï. The erosion of this global health infrastructure leaves the world more vulnerable not only to Ebola, but to the full spectrum of emerging infectious diseases.
Even the most effective tools, like vaccines, cannot stand alone. Ervebo, a single-dose shot, helped stop the 2018-2020 North Kivu outbreak. Zabdeno/Mvabea, a two-dose regimen, promises broader protection. But vaccines don’t deliver themselves. They depend on cold chains, trained health workers, trusted communication, and coordination across borders — exactly the systems now under threat.
Ebola is never just a virus; it is a mirror. Each outbreak reflects the strength — or fragility — of the systems meant to protect us. It forces political leaders to choose whether to act swiftly on science or to stall and deny. It tests whether genomic data will be shared openly, as it was in Kasaï within a day of the outbreak’s declaration, or hidden behind politics. It reveals whether communities trust health care workers enough to cooperate, or whether years of neglect and misinformation drive suspicion.
DRC is grappling with all these questions right now. The troubling difference in 2025 is that the world’s ability to answer them has grown weaker, thinner, and more fragmented than at any time in decades. Outbreaks like the one in Kasaï are not only public health emergencies — they are moments that test the strength of international solidarity, and whether the global response is guided by the urgency of saving lives or undermined by competing political and economic interests.
It is true that the DRC has shown growing capacity in outbreak management, but much of this progress has been built through international collaboration. The country’s sequencing capacity, for example, was developed during prior Ebola outbreaks and expanded when Covid-19 and mpox were officially deemed public health emergencies of international concern by the WHO. That designation allowed the country to access resources from partners, including U.S. technical and financial support. That investment is now being leveraged to generate the rapid genomic sequence which helps guide the current response — a clear example of how U.S. presence has been beneficial. Will such support be available in the future?
And even with the resources provided in the past, major challenges remain. Limited electricity, lack of running water, and shortages of diagnostic supplies make even basic testing difficult. Risk communication is also strained, with communities sometimes resisting interventions or fleeing to neighboring districts. These realities underscore that while local and regional capacity has grown, it cannot be sustained or scaled without continued global collaborations and partnerships.
It may be tempting to view this as the DRC’s problem, yet history reminds us that pathogens know no borders. While the risk of wider spread from Kasaï is low, in an interconnected world no outbreak is truly isolated. The real challenge lies in stopping it at the source — deploying responders, strengthening contact tracing, and ensuring vaccines and care reach those in need.
Global health programs are not charity. They are insurance policies and the most affordable protection we have against future pandemics. Containing outbreaks at their source costs millions. Letting them spread costs billions — and lives.
Kasaï’s outbreak is about more than the DRC; it is a test of whether the United States and the world will continue to treat global health as a shared security priority.
The verdict is not yet written. The flames in Kasaï serve as warning: If we allow global health defenses to erode, the next time smoke rises from a remote corner of the world, the fire may not stay contained.
Krutika Kuppalli is an infectious diseases physician in Dallas. She specializes in emerging pathogens, viral hemorrhagic fevers, mpox, outbreak response, and global health policy.
Source link
