When did the Ebola outbreak raging in DRC begin?
The official declaration came on May 15. But the size and scope — now over 600 suspected cases and 139 deaths — makes disease experts think that it could have been spreading in the Democratic Republic of Congo for weeks, even months.
They're pointing to several reasons — some of them reflecting human decisions, others beyond the control of health authorities.
The rarity of this Ebola species, called Bundibugyo, likely contributed to the delay, health officials say. Standard tests to detect Ebola in the field aren't designed for Bundibugyo, and it took time for samples in Ituri province — the epicenter of the outbreak — to be sent to Kinshasa, more than 600 miles away, for more thorough testing. Ituri province is also rife with armed conflict that's intensified over the past few months, making these logistics even harder.
But for decades, the U.S. government has been investing hundreds of millions of dollars in getting ready for this kind of outbreak, particularly in DRC, which is a hotspot for Ebola and other infectious diseases. That aid was drastically reduced as a result of the Trump administration's dismantling of the United States Agency for International Development and other cuts to foreign assistance..
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"Outbreaks are always going to occur," says Grace Tran, who worked on Ebola preparedness with USAID. "It's more the fact that it circulated for so long, and this thing is much bigger than we've realized. I think that part is related to cuts."
Breakdowns in preparedness
Historically, USAID and the U.S. Centers for Disease Control and Prevention were the main players in supporting disease surveillance and response.
A basic but crucial part of that was logistics. That includes helping transfer viral samples from remote locations to more centralized labs for testing. In this current outbreak, testing started in late April, but delays in shipping samples to Kinshasa, along with improper shipments that degraded the samples, hampered the process.
Typically, USAID helped support that kind of transport, says Ana Budipo-Mbuyamba, who was USAID's health office director in DRC from 2018 to 2023, where she worked on Ebola preparedness and response. U.S. funds also helped train healthcare workers on proper storage and shipment of such samples and helped with the actual shipments from outbreaks to laboratories, too.
"There was a time, particularly in remote areas of Ituri, where we were trying to get samples down to the Goma lab, which USAID supported," says Budipo-Mbuyamba. "We were able to use some of our funding for humanitarian assistance work to get a plane to move some of those samples."
During this outbreak, WHO officials said during a press conference Wednesday that flight cancellations made it difficult to transport material between Kinshasa and Bunia, the largest city in Ituri province.
The CDC has historically played a role in analyzing samples and lending their technical expertise. But on a press call Sunday, CDC Ebola response incident manager Satish Pillai said the U.S. was only informed about the outbreak last Thursday, a day before it was declared.
Typically, the U.S. would be in the loop sooner, and it's unclear why there was a delay. But some experts pointed to the U.S.'s withdrawal from the WHO, and from providing foreign aid more generally, as a potential factor.
"The reality is that the US government is missing in action," says Salim Abdool Karim, head of the Centre for the AIDS Programme of Research in South Africa and member of the Africa CDC emergency committee that's been following the outbreak. "We're not sitting there pining, oh, where's the U.S. government? We've moved on."
Beefing up surveillance systems
Testing is only one small part of surveillance. Someone on the ground – say a health worker or community member – has to get suspicious. Maybe they hear about a cluster of mysterious deaths and flag it to local health officials. And that would lead to swabbing the nose of someone who's sick, and eventually figuring out the cause.
USAID invested heavily in building local health systems, training health care workers and communities to recognize potential outbreaks and respond, says Budipo-Mbuyamba. That work took years of building trust with communities, she says, many of which are often wary of outsiders.
Because of the Trump administration's aid cuts, many of those programs ended, or lost significant funding, she says.
"When you dismantle those programs, you no longer have your frontline eyes and ears on the ground that can alert you," she says. "Not having that, you lose precious time, and then precious lives get lost because of that."
In active conflict areas like Ituri province, often humanitarian workers serve as those eyes and ears. But they've had their funding significantly reduced too, from over $900 million in 2024 to $179 million during the first year of the Trump administration.
One humanitarian organization, the International Rescue Committee, had covered 5 health zones in Ituri before the cuts. They had to scale back to two, says Heather Kerr, IRC's DRC country director, leaving the area more unmonitored.
In a statement to NPR, the State Department said "It is false to claim that the USAID reform has negatively impacted our ability to respond to Ebola. In fact, by bringing USAID global health functions under the new GHSD bureau at the State Department, our efforts are more aligned and effective." On Tuesday, the State Department announced they'd be funding up to 50 clinics to aid in the response, though that could take weeks. They've also mobilized about 23 million dollars in funds to DRC, through the United Nations Office for the Coordination of Humanitarian Affairs.
To Budipo-Mbuyamba, the move comes too late.
"It is so unfortunate and so sad to see all the work that we did, just like, disappear," she says. "There was no reason for the dismantling [of USAID] in such a vicious way, now we're suffering the consequences."
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