Medical staff are sterilised before entering the isolation unit at a hospital in Bundibugyo, western Uganda, on August 17, 2018, where there was a suspected case of Ebola. On May 16, 2026 an outbreak of Bundibugyo virus was declared a public health emergency of international concern. (Photo by SUMY SADURNI / AFP) (Photo credit should read SUMY SADURNI/AFP via Getty Images)
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The World Health Organization has declared the current Bundibugyo ebolavirus outbreak in the Democratic Republic of Congo and Uganda as a public health emergency of international concern, just two days after confirming the outbreak.
This rapid designation is unprecedented. A Public Health Emergency of International Concern (PHEIC) is the highest alert level WHO can issue under the International Health Regulations. Since its inception in 2005, a PHEIC has been declared only nine times: for H1N1 influenza, polio, two previous Ebola outbreaks, Zika, COVID-19, two waves of mpox, and now Bundibugyo. Previously, declarations came after weeks or months of discussion. For instance, the 2014 West Africa Ebola epidemic wasn’t declared until August 2014, eight months after the initial cases in Guinea, with 1,711 infections and 932 deaths. The 2018–2020 outbreak in eastern DRC was not declared a PHEIC until July 2019, nearly a year in, after the virus reached Goma. Both of these declarations faced criticism for being too late, making the current 48-hour response remarkable.
Why So Fast?
According to the WHO, several factors influenced the swift decision. Of 13 laboratory samples, eight tested positive for Bundibugyo virus, indicating widespread infection. At least four healthcare workers have died. There are clusters of cases with no known links, pointing to community transmission that contact tracing has yet to fully capture. Alarmingly, the virus has reached two capital cities: Kinshasa in the DRC, with a population of 17 million, reported a confirmed case on May 16, and two confirmed cases, one fatal, were identified in Kampala, Uganda on May 15 and 16.
This combination prompted the decision. Bundibugyo, an Ebola virus, has no available vaccines or treatments. It causes severe hemorrhagic fever with high fatality and is spreading in a region affected by conflict, with confirmed community transmission and presence in two major cities in central and east Africa. WHO intends to convene an Emergency Committee to issue temporary formal recommendations.
What Does a PHEIC Actually Do?
A PHEIC declaration is a legal tool under the International Health Regulations. It indicates that an event poses a public health risk to other nations through international spread and necessitates a coordinated global response. This allows WHO to issue temporary recommendations regarding trade, travel, and surveillance, and serves as a mechanism to mobilize funding and political focus.
However, it does not provide vaccines that do not exist or address security issues in Ituri Province. The response to Bundibugyo still relies on existing tools: contact tracing, infection control, Ebola treatment units, and safe burial practices. While the PHEIC raises international awareness of the outbreak, its impact on accelerating the response in Mongwalu, Rwampara, and Bunia remains to be seen.
The rapid action by WHO suggests they have learned from past Ebola missteps. The delay in 2014 resulted in significant loss of life. Whether the swift action at headquarters translates into rapid field response is yet to be determined.
