The world isn't ready for this Ebola outbreak | Opinion

On May 16, the World Health Organization declared the Ebola outbreak in eastern Congo and Uganda a public health emergency of international concern. In an unprecedented move, Director-General Tedros Adhanom Ghebreyesus made the determination before convening an emergency committee.

The virus strain is Bundibugyo ebolavirus, a species for which no vaccine or treatment exists. As of May 17, the WHO and Africa Centres for Disease Control and Prevention reported at least 246 suspected cases and 80 suspected deaths.

The virus has crossed into Uganda with two unlinked laboratory-confirmed cases in Kampala, including one death.

Five Ebola veterans and I are clinicians and researchers who have responded to multiple viral hemorrhagic fever outbreaks. This outbreak has every structural condition that turned West Africa's 2014 epidemic into a catastrophe that killed 11,000 people, plus several more that West Africa did not have.

Here are some of the risk factors we see: Kampala is a major international travel hub. Migrant gold miners travel in and out of Mongwalu, one of the epicenters. Refugee camps are located along the border with South Sudan.

Armed militants control parts of the outbreak zone. The outbreak festered for months before anyone confirmed what it was. A local health system has already collapsed: clinics without drugs, personal protective equipment stockpiles gone, trained staff laid off.

There is no vaccine. No treatment. Behind it all is a global health funding architecture at its lowest level since 2009, with the largest single donor having walked away.

We're less prepared for this Ebola outbreak

The danger hasn't changed since 2014. Our ability to respond has.

The United States withdrew from the WHO in January. USAID, which funded contact tracers, border screeners, lab workers and response capacity across central Africa, was dissolved last July, with 80% of its global health awards terminated and $12.7 billion gone.

The Centers for Disease Control and Prevention had a Senate-confirmed director for only about a month under this administration, and currently has no Senate-confirmed leader in place. The Department of Health and Human Services has lost more than 10,000 employees.

National Institutes of Health laboratories that provided vital support have been closed or defunded. HHS Secretary Robert F. Kennedy Jr. once promised to give infectious disease research "a break for about eight years."

Viruses and epidemics don't care about politics

Pathogens do not observe political pauses. A study published in Science found that the regions of Africa most dependent on USAID funding saw a 12% increase in conflict events and a 9% increase in battle-related deaths after the agency was shut down. Endemic disease risks are worsening in the same areas.

Containing Ebola is a workforce equation. One nurse in full protective equipment can deliver 100 milliliters of IV fluid to one patient in one hour. Or one nurse can sit outside the unit and coach 10 patients to drink a liter of fluids each.

During the West Africa epidemic, we chose fluids coaching because it was the only thing that scaled. The community health workers trained for that job had their positions eliminated when USAID funding ended.

In West Africa, blood samples took four days to return. People sat in suspected case wards waiting for confirmation.

Some contracted Ebola while waiting to find out if they had it. As of right now, only a small proportion have been tested. The bottleneck that killed people in 2014 is already forming.

Early Ebola symptoms look like malaria, typhoid and labor pains. Health care workers died on delivery wards in West Africa because they thought they were attending births, not women with Ebola.

In Ituri, clinicians with limited protective equipment are seeing patients with nonspecific symptoms in an area where malaria is everywhere. The early signal is indistinguishable from noise.

Disengaging from Africa bred distrust

But containing Ebola requires more than functional systems. It requires trust.

Communities in West Africa had a phrase for what happened when foreign aid workers arrived: Ebola business. The nongovernmental organizations came with their 4x4s and their large contracts. Then the outbreak ended, and they left.

In eastern Congo, the distrust runs deeper. About $800 million went toward a treatment developed partly from a Congolese survivor's blood.

Yet Congolese patients in subsequent outbreaks struggled to access what their bodies helped create. Rwanda-backed M23 rebels have seized territory across the region, and United Nations investigators have documented mineral smuggling at "unprecedented levels."

In December, President Donald Trump hosted the leaders of Rwanda and the Democratic Republic of the Congo at the White House and announced that U.S. companies would extract rare-earth minerals in both countries.

To Congolese people, that looked like America negotiating with their occupier. M23 seized Goma, eastern Congo's largest city, the same week USAID funding was frozen, collapsing the pharmacy system that supplied medicine to rural clinics.

An estimated 300,000 people have died from treatable diseases since – not from Ebola, not from bullets, but from a health system that stopped working.

Bundibugyo ebolavirus has caused only two recognized outbreaks before. This is already the largest outbreak.

The entire countermeasure pipeline – vaccines, therapeutics, diagnostics – was built for the Zaire species, which is more than 40% genetically different. Nothing in development is close to ready.

That leaves responders with the same interventions available when Ebola first emerged in 1976: find the sick, isolate them, trace their contacts and bury the dead safely.

These steps require trained people, trusted people and funded people. The specific people whose jobs were cut.

This is not a warning about what could go wrong. It is a record of what has been disassembled, meeting a virus that is rapidly spreading, in a place where containment was difficult enough when every institution was intact.

Dr. Céline Gounder is an infectious disease specialist and epidemiologist. She served on the Biden administration transition team's COVID-19 advisory board. Drs. Craig Spencer, Angela Rasmussen, Krutika Kruppalli, Nahid Bhadelia and Megan Coffee contributed to the research for this column.