Ebola Is Only the Beginning

The Ebola outbreak in the Democratic Republic of the Congo is a stunning indictment of the state of global health security. The epidemic should have been containable; few threats are as familiar to health officials and institutions as this one. Ebola viruses were first discovered in northern Congo (then Zaire) in 1976; since then, they have caused 16 outbreaks in that country and dozens more in the region. Ebola remains highly lethal, but over the past five decades, medical professionals and governments have learned how to diagnose the disease, detect its spread, and, when caught early, stop it. Yet the outbreak that has killed over 3,500 people across Congo since early this year is already the deadliest the country has experienced and the fastest spreading in history. Despite recent signs of progress, it is nowhere near being contained. The difficulty containing this year’s Ebola outbreak does not bode well for the world’s ability to respond effectively to future biological threats. Naturally occurring viruses are emerging more frequently. There were 12 recorded outbreaks of Ebola and Marburg, another deadly disease from the same viral family, during the four years of the Biden administration, compared with five during the previous four years; the current Trump administration could well face even more, having already contended with five outbreaks in less than two years. And the risk of an accidental or deliberate release of a deadly virus is growing. A rising number of labs are handling high-risk pathogens, in part because of a research boom following the COVID-19 pandemic, and it is becoming easier and easier to engineer new viruses using artificial intelligence. Earlier this month, the American AI company Anthropic disclosed five cases in which scientists used its AI software Claude for research that could support biological weapons development, including on variants of bird flu that could evade human immunity. The report confirmed fears that AI models could help bad actors access biological weapons. The global health system, meanwhile, has been weakened by the Trump administration’s cuts to disease surveillance and outbreak preparedness programs, both within the United States and abroad. But the system was shaky long before U.S. President Donald Trump arrived on the scene. Global threat monitoring processes have significant gaps, inconsistent funding models delay vaccine development, and most countries underinvest in regular, comprehensive health services. Washington and other donors often step up when a crisis emerges, but scrambling to put together an emergency response is far from the best way to handle a biological threat. That approach is struggling to contain Ebola today. When a new, lesser-known pathogen begins to spread, the world needs to be much better prepared. THE CRISIS IN CONGO The current outbreak in Congo likely began at least eight months ago. Residents of Mongbwalu, a small town in the northeastern part of the country, described entire families dying from a mysterious illness as early as January. The virus spread for months before the Congolese government, with help from the World Health Organization (WHO), was able to confirm the source of the outbreak in mid-May. By then, hundreds of cases had already been detected across multiple communities in Congo, and two cases had been confirmed in Uganda. Some delay in detection is to be expected, given the remote location of the earliest deaths, ongoing conflict in the area, and the rarity of this outbreak’s driver, the Bundibugyo virus. But the fact that no previous Ebola outbreak had spread as far before being detected suggests that the global health system is becoming less, not more, prepared to manage biological threats. Four months after the outbreak was confirmed, responders from the Congolese government, the WHO, and the Africa Centres for Disease Control and Prevention (Africa CDC) are still struggling to contain it. The death rate sits at around 50 percent, much higher than in past Bundibugyo outbreaks, and 60 percent of deaths between mid-July and late August happened outside health facilities. These two patterns suggest that the true numbers of illnesses and deaths are higher than the official figures and that the disease continues to spread beyond the reach of health officials. Although there have been some signs of progress recently, WHO Director General Tedros Adhanom Ghebreyesus has warned that, if the outbreak’s current trajectory continues, the death toll could exceed that of the world’s largest-ever Ebola outbreak, the epidemic that killed more than 11,000 people and infected nearly 30,000 across West Africa between 2014 and 2016. The United States’ withdrawal from the WHO and dissolution of the U.S. Agency for International Development almost certainly weakened the capacity of both the WHO and the Congolese government to respond to the Ebola outbreak. Nicholas Enrich, a career civil servant who briefly led USAID’s global health work in the early months of the Trump administration, has described in his book Into the Wood Chipper how he tried to convince politically appointed USAID leaders to restart contracts for Ebola response efforts that were canceled amid an outbreak of the disease in Uganda that began in January 2025. Although the Trump administration has said that those programs resumed, former USAID partners, including the International Rescue Committee and Oxfam, have confirmed publicly that Washington stopped funding their health programs in eastern Congo in 2025. The Trump administration also fired most of USAID’s health security staff, eliminated a National Security Council team formed after the 2014 Ebola outbreak to focus on health security and biodefense, and left the leadership position in the congressionally mandated White House Office of Pandemic Preparedness and Response Policy vacant for a year. It terminated thousands of staff positions at the U.S. Centers for Disease Control and Prevention, including entire branches of the CDC’s Global Health Center, and prohibited the agency from communicating with the WHO. After all these cuts and restrictions, Ebola was able to circulate for four months without U.S. experts or partner organizations sounding any alarm bells. The Trump administration has insisted its actions have not affected the detection or containment of Ebola: a White House spokesperson asserted instead, in May, that USAID cuts had made the “entire global health apparatus more efficient and responsive.” Yet it is hard to believe that closing offices, firing government staff, and terminating disease detection and response partnerships has nothing to do with the fact that this Ebola outbreak is one of the worst in history. In recent months, Washington has scrambled to close gaps created by earlier cuts, including by filling vacant roles and committing more than $500 million in assistance to the Ebola response—far more than any other country has committed. But these emergency measures become more expensive and less effective when the health systems carrying out the response have already been compromised by aid cuts. A STRUGGLING SYSTEM Perhaps even more alarming than the loss of U.S. support for outbreak prevention is a set of wider failures in the global health system. Catching an outbreak in the first few days or weeks is essential to quickly containing it. But this outbreak has shown that the existing processes for detecting viruses early are insufficient. For decades, health workers have relied on tests for specific pathogens in places known to be at high risk—such as tests for Ebola in Congo or tests for hantavirus in Argentina. Such a system was always destined to fail. Health officials in northeastern Congo had Ebola tests on hand earlier this year, but the tests were not designed to pick up the Bundibugyo species. This will not be the last time an unusual strain of a disease begins to circulate. Viruses change. Infected people get on planes and travel to less monitored regions. Scaling up supplies of existing tests is not a feasible solution to these problems, either; tests are often expensive, and health workers usually need specialized training to administer them. Once Ebola began spreading in Congo, government officials and responders from nongovernmental organizations should have been able to work closely with the communities affected by the disease. Yet distrust and fear have led to hundreds of attacks on health workers and facilities and have generally made it difficult for response teams to identify those who have been infected and take steps to prevent further spread. These obstacles are not surprising. Millions of people across Congo were already dealing with malaria, measles, and malnutrition; more than 20,000 people died of malaria in 2024 alone. But only when Ebola, a disease with the potential to spread around the world, reaches their communities do resources start pouring in from high-income countries and multilateral institutions. People are naturally skeptical of international efforts to contain one emergency when the same global health system is not addressing the other crises they are suffering through. This relative lack of attention to other diseases creates practical problems, too: because the early symptoms of Ebola, such as fever, resemble those of other common illnesses, many people avoid seeking care until they are very sick, increasing their chances of death and the likelihood that they will transmit the virus. The risk of an accidental or deliberate release of a deadly virus is growing. Regional insecurity has also hindered efforts to detect and contain the outbreak. Eastern Congo has been embroiled in conflict for decades, and fighting along the Ugandan and Rwandan borders has worsened in the last few years. An estimated nine million Congolese people have been displaced, many of them having fled to neighboring countries or to overcrowded camps that lack water, sanitation, and basic health services. These camps are already struggling with high levels of malaria, measles, and cholera, and there is a growing risk that Ebola will begin to circulate inside them, too. Meanwhile, violence in the area endangers public health workers and makes it difficult to transport supplies to northeastern Congo. Political leaders are aware that the conflict is slowing progress in the Ebola response. But until they can find a path to peace, health systems need more effective tools for operating in conflict settings, including finding easier ways to transport supplies, creating stockpiles of personal protective equipment for health workers, building stronger partnerships with trusted local leaders who can help spread accurate information, and maintaining functioning health, water, and sanitation infrastructure for displaced communities. Perhaps the most promising element of the Ebola response has been the relatively quick development of vaccines for the Bundibugyo virus. The first vaccine dose was administered in a Phase 1 trial within 12 weeks of the outbreak’s confirmation, half the time it took researchers to reach the same stage during the 2014 Ebola crisis. In part, this speed was facilitated by long-term U.S. and European investments in institutions such as the Coalition for Epidemic Preparedness Innovations (CEPI), a public-private partnership, and the government-run Uganda Virus Research Institute. These and other organizations had collected key materials, built laboratories, and cultivated scientific partnerships in advance so that they were ready to be used in an emergency. Fast as this development process has been, however, it will take months before any of the new vaccine candidates could be used to inoculate the broader public. For now, containment efforts remain fully dependent on public health measures such as contact tracing and isolation, which require a large, well-coordinated response team. Vaccine development needs to move more quickly, but the current system is not designed to make that happen. Too often, funding emerges only after a crisis is underway. Scientists had the capacity to develop and begin testing vaccines and treatments for Bundibugyo virus before the current outbreak; what they did not have was money and political support. FILLING IN THE GAPS The latest Ebola outbreak has exposed serious gaps in the world’s capacity to respond to the most predictable of health emergencies. The next threat could be far more complex. Last month, a paper in Science confirmed the first-ever successful synthesis of a complete, functional viral genome using AI. This month, Anthropic confirmed that scientists in several countries are using its AI models in ways that could cause widespread harm. In the very near future, bad actors may be able to use AI to engineer viruses at home that are intentionally designed to evade human immunity and existing countermeasures. The current crisis should serve as a wake-up call, just as the Ebola outbreak in West Africa did a decade ago. That epidemic spurred the United States and many other countries to invest in new research and development, which resulted in an Ebola vaccine that has since been used to save lives and contain multiple outbreaks. It pushed the U.S. government to create new processes for responding to biothreats and build 13 units on American soil where medical staff can safely care for people infected with Ebola and other highly deadly diseases. And it prompted the African Union to launch the Africa CDC in 2017, improving the continent’s ability to manage regional outbreaks. Today, governments, together with the private sector and multilateral institutions, have a similar opportunity to strengthen global health security. Part of the solution lies in innovation. Some of the same technological advances that are increasing the risk of bioweapons make it possible for the United States and other countries to establish national systems to quickly detect known and unknown biological threats and to rapidly develop tests, treatments, and vaccines when threats emerge. The U.S. government has the financial capacity and the incentives to develop such a system within the next few years and deploy it domestically. Ideally, it would then be extended globally. There would need to be some international agreement about how to pay for the system so that critical countries such as Congo could participate, however, and a few countries, including China, which has refused to share complete information about the origins of the COVID-19 pandemic, may be reluctant to join. Yet even an early warning system that covers most but not all of the globe would be an improvement on the monitoring processes currently in place. Too often, funding emerges only after a crisis is underway. Vaccine development also requires greater investment and political commitment. Institutions such as CEPI are already working to change the current model, which forces scientists to scramble after a health crisis is already underway, by pursuing research on medical countermeasures for entire viral families that can easily be adapted when one particular virus causes an outbreak. But they need time and additional funding. The World Bank and the WHO have estimated that about $10.5 billion in international financing would be needed annually for a full global pandemic preparedness and response system, roughly $2 billion of which would be focused on research and access to vaccines, treatments, and supplies. It’s a large sum, but it’s cheaper than allowing a deadly disease to spread; the COVID-19 pandemic cost the U.S. economy alone an estimated $14 trillion. Governments will need to lead cross-border collaboration on rapid information sharing, plans to manufacture and distribute vaccines and other medical products, and streamlining regulatory and legal systems. But they should also seek partnerships with AI companies, whose technological expertise can help speed up the development of more broadly protective vaccines. Finally, roles need to be more clearly divided among local, regional, and multilateral health institutions. National governments, in partnership with outside actors when needed, must ensure that communities are protected from known threats such as malaria and measles. Africa CDC and other regional institutions, which are more accountable to national governments than global institutions are, should be tasked with building cross-border surveillance and communication systems. And at the multilateral level, the WHO must focus on its core mandate of offering technical guidance on cross-border health threats and helping coordinate outbreak responses rather than submitting to pressure from member states to spread its limited staff and budget across too many health issues. The current ad hoc system relies too heavily on the United States to mobilize people and resources to respond to each new emergency. It has struggled to contain Ebola. And it will struggle even more when a far less familiar pathogen causes an outbreak. Governments need to build a better global health infrastructure before that day arrives. You are reading a free article Subscribe to Foreign Affairs to get unlimited access. - Paywall-free reading of new articles and over a century of archives - Six issues a year in print and online, plus audio articles - Unlock access to the Foreign Affairs app for reading on the go Already a subscriber? Sign In