Treating Every Outbreak as Though It Were Occurring in Our Backyard

What the MV Hondius cruise ship case and the 2026 Ebola outbreak in the DRC reveal about global health equity.

[This post was jointly written by Denise Naniche and Elizabeth Diago, respectively Co-Director and Coordinator of the Preparedness and Response Hub at the Barcelona Institute for Global Health (ISGlobal).]

As of today, May 21^th, there have been approximately 600 suspected cases and 139 suspected deaths from the deadly Bundibugyo ebolavirus in the northeastern Ituri province in the Democratic Republic of Congo (DRC). The first reported case was a health worker who died on April 24^th; then on May 5^th the WHO was informed of a cluster of an unknown illness with high mortality in health workers, and dispatched a rapid response team. The epidemic was declared a public health emergency of international concern (PHEIC) on May 15th. Since then, the WHO and international organizations have launched emergency control activities.

The lost weeks between the first death and declaration of the PHEIC allowed the virus to spread to a wide network of contacts and across borders. While the DRC has experience managing past Ebola outbreaks, the current crisis presents unique challenges. Unlike the more common Zaire ebolavirus, there are no commonly used diagnostic tests which significantly delayed the identification of the disease, nor approved vaccines or specific therapeutic treatments for the Bundibugyo strain. Consequently, management relies on public health measures: active operational case detection based on symptoms and epidemiological links, isolation, contact tracing, and safe burial practices.

A perfect storm

If we rewind a bit, we can see elements of a perfect storm. First, the capacity to respond to and contain an outbreak depends heavily on pre-existing infrastructure. The Ituri Province has experienced decades of armed conflict, creating a prolonged humanitarian crisis that complicates healthcare delivery.

Second, this fragile health system was further strained in July 2025, by the United States administration’s elimination of its approximately $9 billion in aid funding destined for the DRC. These funds were vital for essential health services, HIV programs, and disease surveillance. Local health systems were thus forced to scale down basic operations, which likely included reducing expenditures on infection control and surveillance networks: the very tools needed to sound the alert for the initial cases in Ituri.

Finally, while public health professionals were attempting to contain the spreading Bundibugyo virus in DRC, a separate health event occurred in another part of the world. On May 2^nd, the WHO received reports of a cluster of the deadly Andes hantavirus disease among passengers on the cruise ship MV Hondius. The international response was rapid: by May 10^th, the affected individuals, primarily from Europe and North America, were evacuated and quarantined in their respective home countries. As of today’s, date, the hantavirus outbreak has resulted in 11 cases and 3 deaths, and the WHO classified the global risk to the general population as "low."

Hantavirus-Ebola: two crises, two standards

While the hantavirus cases received swift and extensive media attention across global outlets, coverage of the Ebola outbreak in the DRC appeared less visible and delayed until having reached a dramatic death toll and the WHO declaration of Public Health Emergency of International Concern. This brings us to the overarching theme of equity.

While the hantavirus cases received swift and extensive media attention across global outlets, coverage of the Ebola outbreak in the DRC appeared less visible and delayed until having reached a dramatic death toll and the WHO declaration of Public Health Emergency of International Concern

The apparent difference in media attention is not new. Global news priorities can be influenced by geographical proximity or by the origin of the populations affected, rather than by the level of public health risk. When this trend is replicated in access to resources such as vaccines, low- and middle-income countries are directly disadvantaged, as we witnessed during the Covid-19 pandemic. We need to ensure that the trend in media coverage is not mirrored by international political will and mobilization of resources for the current Bundibugyo-ebolavirus outbreak.

Putting the '100-Day Mission' to its ultimate test

The declaration of a PHEIC on May 15 activates international frameworks and specifically the 100-Day Mission which is a global initiative spearheaded by the Coalition for Epidemic Preparedness Innovations (CEPI) and endorsed by international organization, global political leaders and the private sector in 2021. The objective of this mission is to develop diagnostics, initial therapeutics, and vaccine candidates within 100 days of an outbreak declaration.

We have a responsibility to treat every outbreak as though it were occurring in our backyard

This framework was utilized for the first time during the 2024 Marburg virus outbreak in Rwanda, facilitating clinical trials for investigational vaccines for an epidemic that remained local and was rapidly contained. The current outbreak in the DRC may represent a more stringent test of the 100-day mission due to the magnitude of its spread and the absence of a specific rapid diagnostic test. As the WHO assembly convenes this month and discusses aspects of equity in the pandemic agreement and benefits sharing across the north and south, we have a responsibility to treat every outbreak as though it were occurring in our backyard, because in an interconnected world, it actually is.