Dr. Olayinka Stephen Ilesanmi, an Assistant Professor of Healthcare Administration at Fayetteville State University in Fayetteville, North Carolina, United States, is a former West Africa Regional Programme Lead at Africa Centres for Disease Control and Prevention (Africa CDC) and a former community health physician at University College Hospital (UCH), Ibadan, and a lecturer in global health, Department of Community Medicine, University of Ibadan. He speaks with Sade Oguntola on the implications of the latest Ebola outbreak in the Democratic Republic of the Congo (DRC) and the challenges that could heighten the risk of further spread across Africa and beyond. Excerpts:
How has the delay in international financial, technical, and logistical support affected efforts to contain the Ebola outbreak in the Democratic Republic of the Congo (DRC)?
Delays in international support have made an already difficult Ebola outbreak even harder to control. In outbreak response, time is critical. Every delay in funding, personnel, or essential supplies can mean missed cases, delayed treatment, and more opportunities for the virus to spread. During the 2014–2016 West African outbreak, I worked in Sierra Leone, where international support was substantial. The United States deployed CDC experts, the United Kingdom supported Sierra Leone, and France assisted Guinea. Military personnel, medical teams, and engineers also contributed significantly to the response.
In contrast, although international partners have pledged support for the current outbreak in the DRC, funding gaps and delays in delivering essential resources remain major concerns. These delays affect disease surveillance, contact tracing, patient care, and access to protective equipment. In outbreak control, every delay creates opportunities for further transmission.
Insecurity and ongoing conflict worsen the situation. Recent attacks on health facilities in North Kivu have reportedly forced patients to flee, increasing the risk of community transmission. The DRC’s enormous size, poor road networks, and difficult terrain also complicate the transport of patients, laboratory samples, medical supplies, and response teams.
Although diagnostic and laboratory capacity has improved, identifying and monitoring contacts remains challenging, particularly in conflict-affected communities. Ebola should not be treated as a problem for the DRC alone because infectious diseases do not respect borders. International commitments must translate into timely funding, technical assistance, and logistical support that reach frontline workers.
Based on your experience and previous involvement in Ebola response efforts, do you think the outbreak in the DRC will end soon?
Based on my experience responding to the 2014–2016 Ebola outbreaks in West Africa and the current epidemiological situation in the DRC, I do not expect the outbreak to end soon. Although progress has been made, including improvements in laboratory testing and the introduction of vaccine clinical trials, no vaccine has been approved specifically for the Bundibugyo virus responsible for this outbreak.
One important measure of outbreak control is our ability to link newly confirmed cases to known transmission chains. Ideally, new cases should arise among people already identified and monitored as contacts. When confirmed cases are found outside existing contact lists, it suggests that some infections are going undetected and transmission may be continuing within communities. This remains a major concern in the DRC.
Another challenge is ensuring that all exposed individuals are identified, monitored, and tested when appropriate. Improved laboratory capacity is important, but laboratories can only test samples from people who are identified and reached. Insecurity, population displacement, and difficulty accessing affected communities make surveillance and contact tracing even harder. Until we consistently identify new cases early, trace their contacts, and interrupt transmission chains, it would be premature to suggest that the outbreak is coming to an end.
What does this situation mean for neighbouring African countries, considering how easily people can travel from one country to another?
The risk of Ebola spreading to neighbouring African countries is real and should not be underestimated. Nigeria has previously recorded an imported Ebola case, demonstrating that the virus can cross international borders. Countries bordering the DRC are particularly vulnerable because of frequent population movements, trade, and displacement.
Airport and border screening are important but have limitations. Ebola has an incubation period of two to 21 days. Someone exposed to the virus may travel without symptoms and pass through screening undetected. Although such individuals are not infectious until symptoms develop, they could become ill after arriving in another country.
International travel continues because blanket travel bans have significant economic and social consequences and limited public health benefits. As transmission continues in the DRC, the risk of imported cases remains. The neighbouring countries must strengthen surveillance, contact tracing, laboratory capacity, and cross-border coordination. Early detection and rapid response are essential to preventing wider transmission. The more cases there are, the greater the possibility of cross-border transmission.
Are you concerned that Ebola could become the major epidemic threatening Africa and other continents, considering the recurrence of infectious diseases?
Yes, Ebola remains a serious public health concern, but we must also prepare for other emerging and re-emerging infectious diseases. COVID-19 demonstrated how quickly an infectious disease can become a global health emergency. However, while Ebola poses a serious threat to affected communities and neighbouring countries, the current risk of widespread global transmission remains low.
The DRC has experienced several Ebola outbreaks caused by different Ebola virus species. The current outbreak involves Bundibugyo virus, which has caused outbreaks previously but has no approved vaccine or specific treatment. Viruses can evolve, and new infectious diseases may emerge, creating additional public health challenges.
International travel and increased population movement also create opportunities for infectious diseases to cross borders. People can travel between continents within hours, potentially carrying infections before symptoms develop. Human contact with infected wildlife and environmental changes also contribute to the emergence of infectious diseases.
My major concern is weakening global health security due to reduced international funding, including cuts affecting USAID-supported programmes. These can undermine disease surveillance, laboratory systems, and outbreak preparedness, particularly in resource-limited countries. We must not wait until an outbreak becomes a global emergency before acting. Sustained investment in surveillance, research, health systems, and international cooperation is essential to protecting lives.
Are there studies or surveys on Ebola awareness and knowledge in Nigeria, particularly at the grassroots level?
Yes. During the 2014 Ebola outbreak in Nigeria, awareness was widespread, but many people lacked adequate knowledge of the disease, particularly its transmission and prevention. Even as a medical doctor, I knew about Ebola but had limited practical knowledge because I had never managed a patient with the disease or received extensive training on it during medical school.
In October 2014, shortly before Nigeria was declared Ebola-free, I conducted a study with my colleague, Dr. Faith Alele, among 440 secondary school students in Owo, Ondo State. We found that 95.4% had heard of Ebola, but only 42.3% identified fever as a possible symptom, while 33.2% recognised the risks associated with burial practices. Our findings demonstrated that awareness does not necessarily translate into adequate knowledge or preventive behaviour. We subsequently initiated Ebola health education activities in schools.
Following the recent imported case, Nigeria is not starting from zero. The 2014 experience provided valuable lessons, particularly for healthcare workers. However, misinformation remains a concern. During the 2014 outbreak, some Nigerians drank salt water or bathed in salt water, mistakenly believing these practices could prevent infection.
We therefore need sustained public education, particularly at the grassroots level. The Nigeria Centre for Disease Control and Prevention cannot achieve this alone. The Ministries of Health and Education should collaborate to integrate infectious disease education into primary, secondary, and tertiary institutions. Students can become important sources of accurate health information for their families and communities.
Countries such as Uganda have gained considerable experience managing Ebola outbreaks. Nigeria’s 2014 outbreak was relatively brief, making continuous preparedness essential. These educational efforts should extend beyond Ebola to other infectious diseases, including Lassa fever, which remains a major public health concern in Nigeria despite decades of experience with the disease.
Which is more dangerous: Ebola or Lassa fever?
Ebola generally has a higher case-fatality rate than Lassa fever. The average case-fatality rate for Ebola is approximately 50%, meaning about one in every two reported cases may result in death, although this varies between outbreaks. For Lassa fever, the overall case-fatality rate is about 1%, but it can reach 15–20% among patients hospitalized with severe disease. Therefore, Ebola is generally more deadly in terms of the proportion of cases resulting in death. However, both diseases are serious public health threats that require early detection and prompt treatment.
During a recent trip to Nigeria, I noticed that several passengers hadn’t completed the required health declaration form. Although I completed mine and generated the QR code, I had to assist other travelers. Some lacked internet access, making compliance difficult. This experience showed me that having a policy is one thing, but ensuring people can comply with it is another.
Airlines should verify health declarations before boarding, while authorities must provide reliable internet access and assistance at points of entry. Travellers’ contact details and intended addresses in Nigeria should also be accurately recorded to support rapid contact tracing if a case is detected. The existing declaration system collects this information.
Ebola preparedness should not rest with the health sector alone. The Ministries of Aviation, Education, and Environment must work closely with the Ministry of Health. Hospitals need trained personnel, protective equipment, and clear isolation procedures, while schools need practical health education and reporting mechanisms.
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Nigeria has developed important preparedness guidelines, but their effectiveness depends on consistent implementation, adequate resources, and cross-sector coordination. We must ensure that the systems designed to protect people work in practice.
Are there cultural practices in Nigeria that could contribute to the spread of emerging and re-emerging infectious diseases?
Yes, certain cultural practices can increase the risk of infectious disease transmission, particularly those involving contact with blood or bodily fluids. Examples include unsafe childbirth practices, traditional scarification using unsterilized instruments, and burial rituals involving direct contact with the deceased.
In some communities, water used to wash a dead body is sprinkled on mourners, based on the belief that it prevents future deaths. If the deceased had Ebola, this could spread infection. During my Ebola response work in Sierra Leone, I witnessed how unsafe burial practices contributed to transmission within families.
The solution is not to condemn cultural practices but to engage community and religious leaders in promoting safer alternatives that respect cultural beliefs while protecting lives.
What about scarification and traditional widowhood practices, particularly those involving contact with a deceased person’s body?
Some traditional practices in Nigeria can increase the risk of infectious disease transmission. Scarification using unsterilized instruments can spread bloodborne infections such as hepatitis B, hepatitis C, and HIV. In some communities, widows may be required to stay close to their husbands’ bodies for several days. If the deceased had Ebola, direct contact with infected blood, bodily fluids, or contaminated materials could expose them to infection.
Similarly, burial practices involving washing, touching, or handling the deceased can facilitate Ebola transmission because the bodies of people who die from the disease remain highly infectious. However, simply being in the same room as a corpse does not transmit Ebola without exposure to infectious materials.
Other risks include handling infected wildlife, particularly bats and non-human primates, and consuming inadequately cooked animal products. These activities may expose people to zoonotic infections, although the precise animal source of Ebola outbreaks is not always known. Poor hygiene and overcrowding can also increase the spread of certain infectious diseases.
The solution is culturally sensitive public health education and not condemnation of traditional practices. Engaging traditional and religious leaders to promote safe burial practices, infection prevention, and early reporting of suspected cases is essential to protecting communities. Working with traditional and religious leaders is essential to preventing infections without stigmatising communities.
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