分类： health

In a sobering update on the escalating Ebola crisis ravaging eastern Democratic Republic of the Congo, the Africa Centers for Disease Control and Prevention (Africa CDC) announced Thursday that local health authorities are pivoting to a new village-centered strategy to curb transmission, after the virus outpaced existing containment and tracking efforts.

According to the continental public health agency, the current outbreak has not yet reached its peak, marking a far more severe public health emergency than the devastating 2014–2016 West African Ebola epidemic, which remains the deadliest on record with more than 11,000 fatalities. Africa CDC data confirms the current outbreak has already recorded six times as many confirmed cases and five times as many deaths as that prior crisis.

Since the outbreak was declared in mid-May, the virus has jumped from just three initial health zones to 60 across the country, with 6,250 total confirmed cases and 3,039 deaths as of the latest government count. Ongoing insecurity, mass population displacement, and frequent large-scale population movements have been the primary drivers of the virus’s rapid spread. The outbreak is concentrated in Ituri province, which is also the epicenter of a persistent rebel conflict in eastern Congo – a dual crisis that has complicated nearly every aspect of outbreak response.

A new analysis this week from the U.S. Centers for Disease Control and Prevention (U.S. CDC) identifies five critical gaps that continue to undermine Congo’s Ebola response, even as authorities adjust their strategy.

First, community-based surveillance systems remain drastically underdeveloped. Rapid investigation of potential cases, early detection, contact tracking, and transmission slowdown are all hampered by this gap. Delayed case detection, widespread community reluctance to report suspected infections, and insufficient engagement with local populations have all led to entirely preventable deaths. Recent Africa CDC data underscores this failure: at least 63% of all fatalities recorded in the past week occurred outside of dedicated Ebola treatment centers, meaning most infected people never accessed life-saving care.

To address this foundational gap, authorities are now rolling out the new village-centered approach, which centers on partnering directly with local community leaders to build trust and improve collaborative work with residents. But Yap Boum, head of emergency preparedness and response at Africa CDC, noted that trust-building in the middle of an active conflict and outbreak is far from simple. “Building that trust in the middle of an outbreak is quite complex,” Boum explained, referencing the ongoing insecurity that leaves residents deeply suspicious of outside actors.

The second critical gap is persistent failure to scale up effective contact tracing, an essential tool for stopping Ebola chains of transmission. While response teams have followed up with 81% of *officially listed* contacts of confirmed cases, this statistic hides a stark reality: thousands of unrecorded contacts have never been reached for monitoring. Africa CDC estimates that confirmed cases recorded in the three weeks prior to the update should have generated approximately 97,600 total contacts, based on an average of 60 contacts per confirmed case. To date, only 19% of these total expected contacts have successfully been traced, leaving hundreds of potential transmission chains unmonitored.

Third, experts warn that existing treatment and isolation capacity remains insufficient to meet projected need. By late August, treatment centers had expanded their total capacity to more than 1,300 beds, with a current occupancy rate of 67% (holding 869 patients). However, public health teams are calling for additional treatment and isolation centers and beds across affected health zones to prepare for the wave of undetected cases that experts expect to emerge. Many high-risk health zones are located in areas inaccessible to response teams, while widespread community distrust of health authorities leads to many cases going unreported for weeks.

Fourth, limited laboratory testing capacity continues to delay case confirmation and timely treatment. The World Health Organization reported last month that many treatment and transit centers in Ituri, the outbreak’s epicenter, are already operating at full saturation, while North Kivu – the second-most affected province – lacks enough specialized referral facilities for severe cases. Frontline health workers at existing treatment centers are also suffering from extreme burnout. Jeannot Krikeija, who works at an Ebola treatment center in Bunia, Ituri’s capital, described the relentless toll of the crisis: “Ebola is tiring us all the more because we don’t know when this scourge will end. This ordeal is unbearable for me.”

The fifth and final gap identified by the U.S. CDC lies in safe burial practices, a critical intervention given that Ebola spreads through direct contact with bodily fluids, and the bodies of deceased victims remain highly infectious. While authorities have deployed safe burial teams to respond to the more than 3,000 Ebola deaths to date, major gaps remain in execution across affected health zones. In Ituri and other high-risk areas, burial teams have been attacked multiple times, often by grieving family members who wish to carry out traditional burial customs for their loved ones. It remains common for community members to gather within meters of Ebola victim coffins during burials, putting hundreds of people at risk of new infections.

As the new village-centered strategy rolls out, public health agencies across the continent continue to warn that the outbreak’s trajectory remains unpredictable, with sustained transmission expected for the foreseeable future without targeted investment to close the remaining response gaps.

AP writers Constant Same Bagalwa in Bunia, Congo and Mike Stobbe in New York contributed reporting to this article.

BUNIA, Democratic Republic of Congo – A rapidly expanding Ebola outbreak in eastern Congo has outpaced international and local containment efforts, crossing a grim milestone this week with more than 3,000 fatalities recorded across over 6,100 confirmed cases, new government data released Wednesday confirms.

According to figures from Congo’s Ministry of Health, the outbreak has reached 6,186 confirmed infections since the World Health Organization declared it a global public health emergency in mid-May, with 3,007 confirmed deaths to date. Health officials confirm this is now the fastest-growing Ebola outbreak in recorded history, with transmission accelerating far more quickly than contact tracing and public health teams can respond.

The crisis has upended daily life for communities across affected regions, forcing many residents to flee high-transmission zones to seek safety. Jean-Claude Angwanzia, a Bunia resident who relocated from Mambassa in the Ituri province epicenter, described widespread insecurity and a lack of visible public health support. “I had to flee the area because of the danger looming over us,” he said, noting infected bodies were often mishandled and health workers were rarely seen in the hardest-hit communities.

Local economic and daily activity has slowed dramatically as fear of transmission spreads. Papy Baraka, a public transportation driver based in Bunia, told reporters he has been forced to reduce the number of passengers he carries per trip to lower exposure risk. “The disease puts everyone at risk, and daily life has slowed to a crawl. We are afraid,” he said.

In recent weeks, the virus has expanded its reach at an alarming rate: just last week, two additional health zones in North Kivu province reported their first cases, pushing the total number of affected jurisdictions to 60 across six Congo provinces. The fatality rate in North Kivu is significantly higher than in other impacted regions.

A new assessment released Tuesday by the U.S. Centers for Disease Control and Prevention (CDC) echoed on-the-ground accounts of failing containment, concluding current response efforts “remained below established response targets.” The report warned that the virus’s spread across dozens of health zones signals “uncontrolled expansion of the outbreak.” CDC data shows only 15% to 20% of new confirmed cases stem from known transmission chains, meaning the vast majority of new infections are occurring through unknown, untraced contacts.

Multiple interconnected factors have fueled the outbreak’s unrelenting spread. The eastern Congo region where the virus is concentrated has long grappled with ongoing armed conflict, which disrupts access to impacted communities. Health care workers responding to the crisis have also faced repeated targeted attacks, and have staged multiple strikes over delayed pay and inadequate working conditions. A highly mobile population of artisanal miners moving across regional borders, combined with long-underfunded and underdeveloped local health infrastructure, has further hampered response efforts. Even the recent reopening of schools in the outbreak’s epicenter has sparked widespread concern about rapid transmission among crowded student populations.

The World Health Organization warns the outbreak is on track to surpass the deadliest Ebola event in history: the 2014-2016 West African regional outbreak that killed more than 11,000 people across three countries. The Africa CDC added that official case counts are likely a significant undercount, estimating the actual number of infections could be three times higher than reported due to weak surveillance and contact tracing systems. Even at the current confirmed count, this is already the deadliest Ebola outbreak in Congo’s history.

Unlike previous Ebola outbreaks that have been effectively contained with existing vaccines, the current outbreak is caused by the rare Bundibugyo Ebola virus, for which no fully approved vaccine or targeted treatment currently exists. A small number of vaccine candidates are in late-stage development, however, and last week the Congolese government launched distribution of the Ervebo vaccine – which successfully controlled previous Ebola outbreaks – to front-line health workers in Kisangani, the capital of northeastern Tshopo province. WHO officials note Ervebo may provide at least partial protection against the current variant.

In a grim update released Monday, Democratic Republic of Congo health authorities confirmed that the nation’s unprecedented fast-spreading Ebola outbreak has crossed a devastating threshold, with more than 6,000 confirmed cases and 2,911 fatalities recorded to date. Amid the rising death toll, authorities did highlight one small positive development: over 1,360 patients have successfully recovered from the virus, a trend officials described as encouraging for frontline response teams.

The outbreak, which is centered in eastern Congo, is expanding against a backdrop of extraordinary operational challenges. Chronic regional insecurity, mass population displacement, a recent strike by frontline health workers, and constant large-scale population movements have all combined to accelerate transmission. Displacement camps, where residents already live in overcrowded, unsanitary and precarious conditions, are emerging as particularly high-risk sites for widespread infection. Just last week, health officials confirmed the virus has reached two more previously unaffected health zones, bringing the total number of impacted areas across the region to nearly 60.

The World Health Organization (WHO) has repeatedly warned that the outbreak remains completely out of control, and current projection models indicate it could soon overtake the 2014–2016 West Africa Ebola epidemic as the deadliest outbreak on record. That earlier outbreak killed more than 11,000 people across Guinea, Liberia and Sierra Leone.

Complicating response efforts further, violent attacks against response teams have become increasingly common. On Saturday, an Ebola response team deployed to the outskirts of Mambasa, a town in Ituri province, came under attack while working to safely recover an Ebola-related death. A group of young men armed with machetes stormed the funeral site where the team was operating, forcing all responders to evacuate the area and leaving one team member injured. Floribert Magene, a member of the response team, told the Associated Press that frontline workers are urgently calling for improved protection. “We demand greater security so we can operate in the field and do our work without endangering our lives,” Magene said.

Unlike many previous Ebola outbreaks, this current event is caused by the Bundibugyo strain, a rare variant of the virus for which no officially licensed vaccine or specific treatment currently exists. In a proactive step last week, Congolese health authorities launched a vaccination campaign for health care workers and other frontline response staff using Ervebo, a vaccine that proved effective against Zaire Ebola — the more common strain that caused previous major outbreaks. Clinical trials for a Bundibugyo-specific vaccine are currently ongoing to develop a targeted tool for fighting this outbreak.

Health officials retroactively determined that while the outbreak was formally declared in mid-May, the virus had begun spreading quietly through communities as early as February. It has since expanded from just 3 initial health zones to 60, with data showing that the majority of new cases and deaths are occurring outside of monitored contact tracing networks, spreading undetected within local communities.

Public health control measures, including limits on large public gatherings, social distancing guidelines, and airport closures, have upended daily life across six affected Congolese provinces. Ituri province, which is also grappling with persistent rebel violence that has displaced thousands of residents, has been hit particularly hard by these disruptions. While the Congolese government has rolled out limited interventions, including installing sanitary and medical screening equipment at high-traffic sites, public health advocacy groups emphasize that far more work is needed to build trust with local communities and expand access to care.

Although neighboring Uganda declared itself officially Ebola-free last month after containing a small cross-border outbreak, the WHO warned last week that the risk of future cross-border spread remains elevated, as long as the large-scale outbreak continues to rage in eastern Congo.

On a crisp, cold morning in the mountainous Southern African kingdom of Lesotho, Ntlhane Sehloho slung his backpack stuffed with critical medical gear over his shoulders and set off on a three-hour trek along winding, unpaved gravel roads. His destination: Mpharane Health Center, a small clinic tucked into a remote valley that serves scattered rural communities with limited access to advanced care.

Sehloho occupies a role once almost unheard of in this part of the world: he is a male midwife. When he stepped through the clinic’s doors on this particular morning, a group of waiting women exhaled in relief — some expecting their first child, others balancing fussy infants on their backs, all seeking the routine prenatal and postnatal care Sehloho has provided for 20 years.

For generations, midwifery has been strictly regarded as women’s work in Lesotho’s largely conservative society. But facing one of the world’s worst maternal mortality crises, the country has launched an urgent push to recruit more men into the profession, upending long-held cultural norms to save lives. According to United Nations data, Lesotho records roughly 530 maternal deaths for every 100,000 live births — a rate more than two and a half times the global average of 200.

This crisis is not unique to Lesotho. Sub-Saharan Africa, the world’s fastest-growing region, accounts for 70% of all global maternal deaths, with roughly 180,000 pregnancy-related fatalities recorded across the continent each year. Severe staffing shortages in remote rural clinics, where most of Lesotho’s population lives, have only worsened the crisis. With just over 2 million people nationwide, the country’s rural health posts are chronically understaffed, leaving thousands of pregnant women without access to skilled care during childbirth.

Global health bodies have sounded the alarm for years over this shortage. World Health Organization data estimates that men make up less than 1% of the global midwifery workforce. Both the WHO and UNICEF have called for expanding recruitment to all qualified candidates, regardless of gender, to close gaping gaps in emergency obstetric care.

Sehloho is one of an estimated 300 male midwives now practicing across Lesotho — a milestone that would have been unthinkable a generation ago. The Lesotho government does not track midwifery data by gender, so an exact count is not available, but recruitment efforts over the past two decades have steadily grown the share of men in the field. Sehloho never set out to become a midwife: as a high-achieving student, he originally planned to work as a nurse, driven by childhood memories of preventable tragedy in his rural home village.

“Our village was far away from the health facility, so most pregnant women delivered at home. We were still young, we were not supposed to see that, as some were dying,” he recalled. “I didn’t understand how far they had to travel just to get care.”

After he finished his nursing training, Lesotho’s health authorities encouraged Sehloho and other male nursing graduates to pursue additional midwifery training, part of a targeted strategy to expand care access to underserved rural areas. The strategy has already delivered measurable results: UNICEF data shows that 92% of births in Lesotho now are attended by a trained health provider, up from a far lower share just two decades ago.

Lesotho’s government says the core goal is saving lives, and that gender should never stand in the way of that mission. “I think the system and the community is starting to slowly accept that gender should not matter when it comes to this issue of delivery,” explained Dr. Llang Maama, acting director of health services at Lesotho’s Ministry of Health. She acknowledged that a small number of patients still report discomfort with male midwives, and the health system formally accommodates those requests when possible. “But in the urgency of childbirth, there isn’t always time to choose,” Maama added.

For Sehloho, acceptance comes down to building trust, one patient at a time. A talkative, quick-witted provider, he makes a point of putting pregnant women at ease from their very first prenatal visit, often sharing his own background growing up in a rural Lesotho community and highlighting his 20 years of experience delivering babies. “We are a very cultural and traditional African society,” he said.

Blandina Motaung, a representative for the United Nations Population Fund, which partners closely with Lesotho’s midwifery community, said public reactions to male midwives remain mixed, but many patients are surprised by the unique strengths men bring to the role. Many patients report that male midwives tend to be more gentle and less strict than their female counterparts during consultations, she said. During prenatal checks, Sehloho routinely pauses after taking blood pressure or measuring fetal progress to ask patients if they are comfortable, a small habit that has won him loyalty among the community he serves.

Motaung noted that while most female midwives have personal experience with childbirth, men’s lack of that firsthand experience often makes them more attentive to small changes and warning signs that can signal complications. “For the men, because they have not been through the process, they become more vigilant and more attentive to the nitty gritties, and that in itself improves the quality of care that they provide,” she explained.

Patients across the country are slowly adapting to the new norm. Mpolokeng Mafereka, a 21-year-old patient at Mpharane Health Center, said she still prefers care from a female provider, but has grown accustomed to seeing Sehloho when he is the only clinician available. “I’m used to being treated by women,” she said.

But 21-year-old Bonolo Tebello, another patient at the clinic, said she has never had concerns about seeing a male midwife. “I’m happy to be treated by a male because they still provide the same level of care,” she said. “Even when one arrives late for a check-up, they just treat you like any other person who arrived on time.”

This reporting is part of AP News’ Africa Pulse series, supported by a grant from the Gates Foundation. The Associated Press maintains full editorial control over all funded content.

KAMPALA, Democratic Republic of Congo – In a urgent, long-awaited step to curb the deadliest Ebola outbreak the nation has ever faced, Congolese health authorities officially launched a nationwide vaccination campaign on Thursday in the eastern provincial capital of Kisangani, Health Minister Roger Kamba announced.

The campaign prioritizes high-risk groups first, with frontline health workers, response personnel and close contacts of confirmed Ebola patients topping the list of those to receive doses. Minister Kamba confirmed that the campaign will use the Ervebo vaccine, currently the only widely available Ebola vaccine authorized for emergency use. As of this week, government data puts the outbreak’s toll at 5,713 confirmed cases across six affected provinces – Ituri, North Kivu, South Kivu, Tshopo, Haut-Uele, and Bas-Uele – with 2,744 recorded deaths, translating to a 48% mortality rate among confirmed infections.

This current outbreak, driven by the rarely-seen Bundibugyo Ebola variant, has spread rapidly against a backdrop of crippling systemic challenges: persistent regional insecurity, mass population displacement, a recent nationwide strike by health care workers, and unregulated cross-community population movements. The World Health Organization (WHO) has warned the outbreak remains fully out of control, and is on track to exceed the 2014-2016 West Africa Ebola epidemic – the previous global deadliest on record, which claimed more than 11,000 lives across Guinea, Liberia and Sierra Leone.

To address the crisis, global health bodies have fast-tracked vaccine shipments to Congo. Congolese state media confirm the country has already received more than 50,000 doses of Ervebo, while the WHO approved a total of 70,000 doses for deployment in the outbreak response last week. Of the total approved doses, 50,000 are allocated to frontline and at-risk health workers, with the remaining 20,000 reserved for a clinical trial investigating Ervebo’s efficacy against the Bundibugyo variant.

Crucially, Ervebo is only formally approved to protect against Zaire ebolavirus, a different strain of the virus, and no vaccine is yet specifically authorized for Bundibugyo Ebola. The rollout is proceeding under a compassionate use framework, which permits unapproved off-label use of medical products during public health emergencies when no targeted alternatives exist. Health officials note that the two Ebola strains are genetically related, leading experts to hypothesize Ervebo may offer partial cross-protection, though this hypothesis remains unconfirmed and is the subject of ongoing clinical investigation.

Placide Mbala Kingebeni, director of research, clinical trials and innovation at the Africa Centers for Disease Control and Prevention (Africa CDC), confirmed that systematic efficacy data will be collected throughout the vaccination campaign to answer critical questions about Ervebo’s performance against Bundibugyo Ebola. The initial phase of the campaign will target 14 high-risk health zones across Tshopo, Bas-Uele, and Haut-Uele provinces, the three current hotspots of transmission.

In his remarks launching the campaign, Kamba issued a strong call to action for all frontline health workers to accept vaccination, emphasizing that protecting care providers not only saves their lives, but also prevents secondary transmission of the virus from health settings into the broader community.