Global Pulse

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  • A look at major Ebola outbreaks and when the disease was first identified

    A look at major Ebola outbreaks and when the disease was first identified

    CAPE TOWN, South Africa – African public health authorities have confirmed a new Ebola outbreak in the Democratic Republic of the Congo’s northeastern Ituri province, reporting at least 246 suspected infections and 65 fatalities as authorities move to contain the spread of the highly lethal pathogen.

    First identified nearly 50 years ago following two back-to-back outbreaks in what is now South Sudan and the Democratic Republic of Congo (then known as Zaire), Ebola has remained an endemic threat almost exclusively to sub-Saharan Africa, with all major recorded outbreaks concentrated in West and Central African regions, according to the World Health Organization (WHO).

    The disease is triggered by a group of RNA viruses within the Filoviridae family, with three strains — Ebola virus, Sudan virus, and Bundibugyo virus — responsible for all large-scale public health emergencies in recorded history. Researchers trace the virus’s natural reservoir to fruit bat populations native to the African continent, though other wild animals including gorillas, chimpanzees, and monkeys can also carry and transmit the pathogen to humans. Human-to-human transmission occurs exclusively through direct contact with infected bodily fluids — such as blood, feces, or vomit — or contact with contaminated surfaces and materials, making frontline health workers particularly vulnerable to infection during outbreaks.

    According to the U.S. Centers for Disease Control and Prevention (CDC), Ebola symptoms develop between two days and three weeks after initial exposure, with most patients showing signs of infection roughly one week after contact. Early infection presents with flu-like indicators including fever, muscle aches, general fatigue, and sore throat, progressing in severe cases to gastrointestinal distress, organ damage, skin rashes, seizures, and internal or external bleeding. WHO data puts the average Ebola fatality rate at around 50%, though historical outbreaks have recorded mortality rates ranging from 25% to as high as 90% depending on the viral strain and speed of public health response. While approved vaccines and targeted treatments exist for the Ebola virus strain, no comparable medical countermeasures are currently cleared for other pathogenic Ebola strains.

    This new outbreak marks the latest in a long history of Ebola emergencies across Central Africa, with the most severe event on record occurring just over a decade ago between 2013 and 2016 across West Africa. That epidemic, which began when a young child in southeastern Guinea came into contact with infected fruit bats according to researcher estimates, spread across Guinea, Liberia, and Sierra Leone, causing more than 28,000 confirmed and suspected cases and over 11,000 deaths. A small number of secondary cases were also recorded in Europe and the United States, linked to returning travelers and healthcare workers who had responded to the outbreak.

    The second-largest Ebola outbreak in history took place between 2018 and 2020, centered in Congo’s North Kivu, South Kivu, and Ituri provinces, with a small number of cases spreading across the border to Uganda. Caused by the Ebola virus strain, that outbreak recorded more than 3,400 cases and over 2,200 deaths, resulting in a 66% fatality rate per CDC data. Congo has recorded more than a dozen major Ebola outbreaks in modern history, including one as recent as late 2024.

    A notable 2000-2001 outbreak in Uganda, caused by the Sudan virus strain, resulted in 425 reported cases and 224 deaths. Ugandan public health authorities were widely commended for their rapid, community-centered response, which included widespread public education on transmission risks and efforts to counter dangerous misinformation, limiting the outbreak’s geographic spread. The East African nation has also faced multiple smaller Ebola events in the decades since.

    The first officially recognized Ebola outbreaks were recorded back in 1976, 48 years before the current event. The first, in what was then Sudan (now part of South Sudan), was traced to a cotton factory where workers came into contact with roosting bats, and was later identified as the Sudan virus strain. That initial outbreak caused 284 confirmed cases and at least 151 deaths, with many secondary infections among healthcare workers who treated patients before the unknown virus was identified. Just months later, a separate outbreak in a remote village near the Ebola River in northern Zaire (now the Democratic Republic of Congo) resulted in 280 deaths and an extremely high fatality rate, leading scientists to identify and name the Ebola virus. The first recorded Ebola infection outside Africa occurred the same year, when a British laboratory technician accidentally pricked himself with a contaminated needle while studying virus samples; he ultimately recovered. To date, only a tiny handful of Ebola cases have been recorded outside of the African continent.

    Public health teams have not yet released additional details on the current outbreak’s genetic sequencing or ongoing containment efforts as of the initial announcement.

  • New deadly Ebola outbreak hits DR Congo

    New deadly Ebola outbreak hits DR Congo

    African public health authorities announced Friday the confirmation of a new Ebola outbreak in the northeastern Ituri Province of the Democratic Republic of the Congo (DRC), warning of heightened risks of widespread transmission due to long-running regional insecurity, unregulated cross-border movement, and strained local health infrastructure.

    As of the latest update from the Africa Centres for Disease Control and Prevention (Africa CDC), the outbreak has already been linked to 65 deaths among 246 suspected cases, with preliminary lab results confirming Ebola infection in 13 tested samples, four of which were fatal. Suspected cases have also been detected in Bunia, Ituri’s provincial capital home to 300,000 residents, and confirmation testing is currently underway.

    This new event marks the 17th recorded Ebola outbreak the DRC has faced since the virus was first identified in the region in 1976. The country’s most devastating outbreak, which ran from 2018 to 2020, claimed nearly 2,300 lives, while the prior outbreak, declared in August 2023 in central DRC, was only eradicated in December 2023 after killing at least 34 people.

    Ituri Province, which shares borders with Uganda and South Sudan, presents unique challenges to outbreak response. The region’s gold-rich geology has drawn thousands of artisanal miners, creating constant, unregulated cross-border and internal population movement that can accelerate viral spread. For more than a decade, the area has also been roiled by recurring inter-militia violence, which has restricted access to remote communities and displaced tens of thousands of people into crowded urban settlements — conditions that dramatically increase the risk of person-to-person transmission.

    Preliminary genetic analysis suggests the circulating strain is not the Zaire ebolavirus variant, the deadliest form of the disease with a case fatality rate of 80 to 90 percent, and the only strain for which an approved vaccine currently exists. Full genomic sequencing is still ongoing to confirm the strain’s identity to guide response efforts.

    Local residents and community leaders report a sharp spike in unexplained deaths since mid-April, with some areas recording five to six fatalities per day. “For the past few weeks, the municipality of Mongbwalu has been recording a cascade of deaths, with at least five to six people dying every day in the streets,” local resident Gloire Mumbesa told Agence France-Presse. “We just dug graves to bury three people, but we don’t actually know what these people died of. We’re starting to be afraid of every possible case of illness,” added Salama Bamunoba, a civil society organizer in Rwampara health zone.

    Confirmed and suspected patients are currently isolated in local health facilities, but an anonymous local health source confirmed that frontline workers are facing critical shortages of personal protective equipment and other essential supplies. Logistics also present a major barrier to response across the DRC, a country four times the size of France with sparse, poorly maintained road infrastructure that makes rapid delivery of medical supplies and personnel difficult.

    Response teams from the World Health Organization and medical humanitarian organization Doctors Without Borders have already deployed to the affected region to conduct risk assessments, scale up testing, and support contact tracing efforts. Over the past 50 years, Ebola — a viral hemorrhagic fever spread through direct contact with infected bodily fluids that causes severe bleeding and organ failure — has killed an estimated 15,000 people across Africa, even with the development of effective vaccines and treatments for the Zaire strain. While recent outbreaks have been contained far more effectively than the 2014 West African epidemic that killed over 11,000 people, ongoing insecurity and weak health systems in central Africa continue to create risks of large-scale transmission.

  • What to know about new Ebola outbreak that has killed 65 people in Congo

    What to know about new Ebola outbreak that has killed 65 people in Congo

    Africa’s leading regional public health authority has officially declared a new Ebola outbreak in the Democratic Republic of the Congo’s (DRC) northeastern Ituri province, triggering urgent coordinated response efforts across Central Africa amid alarming early mortality figures.

    In a formal statement released Friday, the Africa Centres for Disease Control and Prevention (Africa CDC) announced that health workers have already documented 246 suspected cases and 65 fatalities linked to the outbreak across the affected region. To date, only four of the recorded deaths have received full laboratory confirmation, but public health officials formalized the outbreak declaration following a sustained surge in suspected infections.

    The outbreak is concentrated in the remote, under-resourced Mongwalu and Rwampara health zones of Ituri, a province located more than 1,000 kilometers (620 miles) from the DRC’s capital, Kinshasa. Suspected cases have also been identified in Bunia, Ituri’s provincial capital, highlighting early signs of geographic spread. The region’s underdeveloped road infrastructure and remote location have long complicated large-scale public health responses, a challenge that looms large over current containment work.

    Public health leaders have flagged multiple high-risk factors that could accelerate the virus’s spread beyond DRC’s borders. Most notably, the affected zones sit in close proximity to the national borders with Uganda and South Sudan, while frequent cross-border population movement, including migration linked to regional artisanal mining operations, creates constant transmission risk. Compounding this danger is the ongoing security crisis in Ituri, where violent attacks by armed groups over the past year have killed dozens of residents and displaced thousands, disrupting health care access and contact tracing efforts. Africa CDC also noted critical gaps in contact listing, a core process for identifying and isolating people exposed to the virus, as local teams work to scale up response operations.

    Despite these challenges, urgent action to contain the outbreak is already underway. The Africa CDC has partnered with Congolese national health authorities and global public health partners to launch a rapid, coordinated response. On the same day the outbreak was confirmed, the agency convened an emergency high-level coordination meeting bringing together health officials from DRC, Uganda, and South Sudan, alongside representatives from United Nations agencies, international donor nations, and global health organizations. The meeting focused on aligning priorities for immediate intervention, strengthening cross-border surveillance and coordination, establishing protocols for safe, dignified burials (a key step to reducing transmission), and mobilizing critical financial and logistical resources for the response.

    While safe, effective vaccines for Ebola do exist, response teams face significant logistical and financial barriers that mirror challenges from past outbreaks in the region. The DRC, Africa’s second-largest country by land area, has a long history of struggling to deploy rapid vaccine distributions due to poor infrastructure and vast distances between population centers. During a 2023 Ebola outbreak, for example, the World Health Organization required a full week to deliver vaccine doses after the outbreak was formally confirmed. Funding gaps have also plagued past responses, with public health officials raising alarms last year over the impact of United States funding cuts to outbreak response programs, even after the U.S. Agency for International Development contributed up to $11.5 million to support regional Ebola response efforts across Africa in 2021.

    This new outbreak marks the 17th recorded Ebola event in the DRC since the virus was first discovered in the country in 1976. It comes just five months after the DRC declared its previous Ebola outbreak over in December 2023, which claimed 43 lives. The 2022 outbreak in the country’s Equateur province killed six people, while the devastating 2018–2020 outbreak in eastern DRC killed more than 1,000 people — the deadliest Ebola event on record since the 2014–2016 outbreak across Guinea, Sierra Leone, and Liberia that killed more than 11,000 people.

    First identified near the Ebola River in what is now the DRC, the Ebola virus is highly contagious and can jump to human populations from wild animal hosts. Once introduced to human communities, it spreads through direct contact with contaminated bodily fluids including blood, vomit, and semen, as well as contact with surfaces and materials such as bedding and clothing that have been exposed to these fluids. Ebola causes severe, often fatal illness in humans, with common symptoms including fever, muscle pain, vomiting, diarrhea, and in advanced cases, internal and external bleeding. The first documented outbreaks occurred in remote Central African villages near tropical rainforests, where human contact with wild animal populations put communities at risk.

  • New outbreak of Ebola kills 65 in eastern DR Congo

    New outbreak of Ebola kills 65 in eastern DR Congo

    The Africa Centres for Disease Control and Prevention (CDC Africa) has publicly confirmed a new Ebola outbreak in the Democratic Republic of Congo’s northeastern Ituri Province, marking the 17th recorded occurrence of the deadly viral pathogen in the Central African nation since the virus was first discovered in 1976.

    According to the regional health body’s official statement released Friday, the outbreak has so far been linked to 246 suspected cases and 65 confirmed deaths, with the vast majority of infections concentrated in two gold-mining communities: Mongwalu and Rwampara. Preliminary laboratory analysis conducted by the Institut National de Recherche Biomédicale (INRB) in DR Congo’s capital Kinshasa has returned positive Ebola results for 13 out of 20 tested samples, with just four of the total fatalities recorded among lab-confirmed cases. Health officials are also awaiting test results for additional suspected cases that have recently emerged in Bunia, Ituri’s provincial capital.

    As of Friday afternoon, the Congolese national government had not yet issued an official declaration of the outbreak, with a senior government staffer confirming to the BBC that a formal press conference addressing the situation was scheduled for later the same day.

    To contain the spread of the virus, CDC Africa announced it has convened an urgent coordination meeting with DR Congo’s national health authorities, alongside neighboring nations Uganda and South Sudan, and other global public health partners. The gathering will focus on aligning rapid response measures and strengthening cross-border disease surveillance, a critical step to prevent the outbreak from spilling into adjacent countries.

    Ebola, which scientists believe originates in fruit bat populations, first emerged in what is now DR Congo in 1976. The virus spreads exclusively through direct contact with infected bodily fluids, and causes rapid onset of severe symptoms including fever, muscle aches, extreme fatigue, sore throat, and eventually progresses to widespread internal bleeding and organ failure. To date, no definitive cure for Ebola exists, though early supportive care significantly improves patient survival outcomes.

    The current outbreak unfolds against a complex security backdrop in Ituri, which has been under direct military rule since 2021. The Congolese government imposed military governance on the region to counter a decades-long presence of dozens of armed insurgent groups, including the Islamic State-affiliated Allied Democratic Forces (ADF), which has carried out frequent attacks on civilian and government targets across the province for years. This security instability poses additional challenges to rapid deployment of public health response teams to affected communities.

    DR Congo has a long history of Ebola outbreaks, with the country’s deadliest event on record occurring between 2018 and 2020, when the virus claimed nearly 2,300 lives. Just last year, an outbreak in the country’s central Kasai Province killed 45 people. Across all African nations, Ebola has killed approximately 50,000 people since it was first identified 50 years ago.

  • Africa’s top health body confirms new Ebola outbreak in remote Congo province

    Africa’s top health body confirms new Ebola outbreak in remote Congo province

    KINSHASA, Democratic Republic of the Congo — Africa’s leading public health authority, the Africa Centres for Disease Control and Prevention (Africa CDC), announced Friday the official confirmation of a fresh Ebola outbreak in the remote northeastern province of Ituri. As of the announcement, the emerging outbreak has recorded 246 suspected infections and 65 fatalities across affected areas.

    Per the agency’s official statement, the vast majority of suspected cases and deaths have been concentrated in two local health zones: Mongwalu and Rwampara. Of the laboratory-confirmed cases identified to date, four have ended in death, while a small number of additional suspected cases detected in the regional city of Bunia are still awaiting confirmatory testing, Africa CDC added.

    First identified in what is now the Democratic Republic of the Congo (DRC) in 1976, the Ebola virus is an extremely contagious pathogen that spreads through direct contact with infected bodily fluids including blood, vomit, and semen. While infections remain relatively rare, the disease it triggers causes severe, often life-threatening illness with a high fatality rate.

    This latest public health emergency comes just five months after the DRC declared an end to its previous Ebola outbreak, which claimed 43 lives before being contained. Friday’s confirmation marks the 17th Ebola outbreak the country has faced since the virus was first discovered on its soil nearly five decades ago. The deadliest recent outbreak occurred between 2018 and 2020 in eastern DRC, killing more than 2,000 people.

    Ituri, the epicenter of the new outbreak, is a remote region located more than 1,000 kilometers (620 miles) from the DRC’s capital Kinshasa, marked by underdeveloped, fragmented road infrastructure that complicates rapid response efforts. The challenge of containing the outbreak is compounded by long-running instability in eastern DRC, where the central government has battled multiple active armed insurgencies for years.

    The M23 rebel group, which launched a large-scale offensive in early 2023, currently occupies key population centers in the region, while Ituri specifically faces ongoing attacks from the Allied Democratic Forces, a militant organization linked to the Islamic State that has killed dozens of civilians in recent months across the province.

    As Africa’s second-largest country by land area, the DRC has long struggled with systemic logistical barriers to rapid disease outbreak response. During the 2023 Ebola outbreak, which spanned three months, the World Health Organization reported major early hurdles to rolling out vaccination campaigns, hobbled by limited access to affected communities and critical funding shortages.

    Public health experts warn that the combination of poor infrastructure, ongoing conflict, and historical response gaps create significant risks that this new Ebola outbreak could spread faster than response teams can contain it, placing added strain on the already overstretched local health system.

  • Australia records first diphtheria fatality in almost a decade after person dies in the NT

    Australia records first diphtheria fatality in almost a decade after person dies in the NT

    Australia is confronting its first diphtheria-related fatality in almost a decade, as public health agencies race to contain a growing national outbreak that has already infected more than 160 people across multiple jurisdictions. The death, which occurred in a remote community of Australia’s Northern Territory (NT) within the past few weeks, was confirmed by Dr. John Boffa, a senior public medical officer at the Central Australian Aboriginal Congress, in an interview with the Australian Broadcasting Corporation.

    According to data from the Australian Centre for Disease Control, this is the first fatal diphtheria case recorded in the country since 2018. Diphtheria is a highly contagious bacterial infection that can spread rapidly through close human contact, and before widespread vaccination rollouts, it was one of the leading causes of death among Australian children. The disease was largely eliminated across the nation after a national vaccine program launched in the 1940s, thanks to the high efficacy of routine immunization in stopping transmission.

    The current outbreak marks the NT’s first widespread resurgence of diphtheria since the 1990s. As of the latest updates, more than 100 confirmed cases of both respiratory and cutaneous diphtheria have been recorded in the territory alone, with a number of patients requiring admission to intensive care units for severe complications. Dr. Boffa emphasized that the vast majority of patients developing serious illness are either fully unvaccinated or have not received their required booster doses, highlighting the critical gap in immunization that has allowed the outbreak to take hold.

    Across the entire country, official case counts have reached 161, with additional infections detected in Western Australia, Queensland, and South Australia. Dr. Boffa noted that the existing diphtheria vaccine is well-proven, safe, and highly effective at preventing severe illness and transmission, and it remains the only viable tool to bring the current outbreak under control.

    He added that the outbreak is placing extraordinary strain on already overstretched remote primary healthcare clinics in the NT, which are being forced to redirect limited core resources to contain the spread due to a lack of additional surge staffing and emergency funding. “We don’t want to be taking three or four years to get boosters into people’s arms – we need to get it done quickly,” Dr. Boffa said, urging at-risk community members to check their immunization status and get a booster as soon as possible to protect themselves against the potentially fatal disease. Requests for additional comment have been made to NT Health authorities.

  • 6 passengers from hantavirus-hit ship arrive in Australia for 3-week quarantine

    6 passengers from hantavirus-hit ship arrive in Australia for 3-week quarantine

    In the wake of a deadly hantavirus outbreak that has claimed three lives aboard an Antarctic cruise ship, six passengers with potential exposure to the virus touched down in Australia on Friday to start a mandatory quarantine set to last a minimum of 21 days. The long-range Gulfstream business jet that transported the group from the Netherlands landed at RAAF Base Pearce, a military airfield located just outside Perth, the capital of Western Australia. Following their arrival, all passengers and the jet’s crew were transported to a purpose-built quarantine facility in the nearby town of Bullsbrook, according to Australian health officials.

    Australian Health Minister Mark Butler confirmed last Thursday that national authorities have put in place what he described as one of the strictest and most robust quarantine protocols anywhere in the world to address this public health event. Of the six passengers entering quarantine, five hold Australian citizenship and one is a citizen of New Zealand. The Bullsbrook facility they are occupying was originally constructed in 2022 as part of Australia’s response to the COVID-19 pandemic, but has stood almost entirely unused since its completion, until this hantavirus response.
    Butler noted that officials have not yet finalized what additional precautionary measures will be put in place after the initial three-week quarantine period ends. The World Health Organization has stated that hantavirus can have an incubation window of up to 42 days, meaning potential infection could remain undetected beyond the initial 21-day isolation period. Other passengers from the affected cruise ship, the MV Hondius, who returned to their home countries in the United States and the United Kingdom, are completing their quarantine periods at their personal residences, Butler added.
    All six passengers tested negative for hantavirus prior to departing the Netherlands, and none have shown any clinical symptoms of the virus as of their arrival in Australia, according to Butler. The outbreak, which was detected mid-voyage, has resulted in 11 confirmed cases among people aboard the MV Hondius, three of whom have died from complications linked to the infection.
    The MV Hondius was operating an expedition cruise that departed Argentina for Antarctica, before continuing on to visit a number of remote isolated islands across the South Atlantic when the outbreak was first identified. After the evacuation of all passengers and most of the ship’s crew was completed, the vessel set sail back to the Netherlands, where it will undergo a comprehensive professional cleaning and full disinfection process before returning to service.

  • France allows asymptomatic passengers off new cruise ship struck by stomach bug outbreak

    France allows asymptomatic passengers off new cruise ship struck by stomach bug outbreak

    BORDEAUX, France – A public health incident that kept more than 1,700 passengers and crew confined to a British cruise ship off the French Atlantic coast has entered a new phase, with local authorities allowing all unaffected guests to leave the vessel Wednesday evening, after confirming the outbreak stems from the highly contagious stomach bug norovirus.

    The Ambition, operated by UK-based Ambassador Cruise Line, had been mid-voyage on a 14-night itinerary departing from Belfast and Liverpool, with planned stops across northern Spain and coastal France, when widespread gastrointestinal symptoms were reported among people on board. The ship docked in Bordeaux on Tuesday evening, and French public health officials immediately issued a full lockdown order, requiring all passengers and crew to stay on board to contain the spread of the pathogen.

    Within a day, officials adjusted the policy, clearing guests who showed no signs of illness to disembark. Photos and on-scene observations captured one passenger exiting the ship with arms raised in a gesture of relief and celebration. As of Thursday, officials had not released an exact count of how many people took advantage of the permission to leave.

    Testing conducted at Bordeaux University Hospital confirmed norovirus as the source of the outbreak, ruling out any connection to the recent deadly hantavirus outbreak on a Dutch vessel that had put European public health agencies on high alert in recent weeks. Local health officials added that no severe cases of illness have been recorded so far, and passengers experiencing symptoms are receiving ongoing care from the cruise ship’s in-house medical team.

    It remains unclear whether the Ambition will resume its scheduled journey, and if so, when operations will restart.

    The outbreak aligns with broader patterns of norovirus spread on cruise ships documented by global health authorities. The U.S. Centers for Disease Control and Prevention, which tracks gastrointestinal illness outbreaks on cruise vessels calling at both U.S. and international ports, recorded 23 separate outbreaks on cruise ships last year. The vast majority of these outbreaks, including one caused by a newly identified strain, were linked to norovirus, a pathogen known for spreading quickly in enclosed communal settings such as cruise liners.

    Ambassador Cruise Line, the operator of the Ambition, is a UK-based company founded in 2021 that focuses on serving travelers over the age of 50.

  • Indian pharma fuels Africa’s ‘zombie drug’ and opioid crisis

    Indian pharma fuels Africa’s ‘zombie drug’ and opioid crisis

    West Africa is currently grappling with an explosive, deadly opioid epidemic that can be traced directly to unregulated, high-strength tapentadol exports from Indian pharmaceutical manufacturers, a months-long Agence France-Presse investigation has confirmed. Sold openly at roadside kiosks and unlicensed street pharmacies across the region, these cheap, unapproved pills are not only driving widespread addiction and death but are also being mixed into the devastating “zombie drug” kush, worsening an already catastrophic public health emergency.

    Unlike regulated prescription painkillers sold globally, the tapentadol flooding West African markets comes in doses so potent that no national regulatory authority anywhere in the world has authorized them for human use. Despite India’s 2025 pledge to crack down on this illicit trade after international outcry over harm caused to African communities, customs and shipment records reviewed by AFP show millions of dollars worth of these unapproved high-strength pills continue to flow out of Indian ports every month, bound for Nigeria, Sierra Leone, Ghana and other West African nations where even low doses of tapentadol are explicitly banned. Many shipments are deliberately mislabeled as “Harmless Medicines for Human Consumption” to evade border inspections.

    Public health and law enforcement officials across the region say the crisis has reached catastrophic levels. In Sierra Leone, where kush mixed with tapentadol has already been declared a national emergency, authorities collect hundreds of bodies of overdose victims from streets, open-air markets and overcrowded slums every three months — just in the capital Freetown alone. Ansu Konneh, director of mental health at Sierra Leone’s ministry of social welfare, described the addition of tapentadol to the already destructive kush cocktail as “very alarming”. Freetown-based public health researcher Ronald Abu Bangura confirmed that tapentadol is now ground into powder and mixed with kush for distribution, adding that the drug is “being misused all over the place”.

    AFP’s investigation cross-checked licensing numbers on seized tapentadol tablets across four West African nations against Indian export records, linking multiple prominent Indian pharmaceutical firms directly to the illicit trade. Gujarat Pharmaceuticals, whose manufacturing license number appeared on seized tablets in both Sierra Leone and Guinea, has been listed in export monitoring databases as a major tapentadol supplier to the region. Merit Organics, another Gujarat-based company, also had its license number found on seized shipments in Guinea. Madhya Pradesh-based McW Healthcare exported more than $1 million worth of 250mg tapentadol tablets to Sierra Leone and Nigeria after India’s February 2025 ban, while PRG Pharma shipped multiple consignments mislabeled as harmless medicines. The investigation also identified Syncom Formulations as the largest single tapentadol exporter to West Africa by value, moving nearly $15 million worth of unapproved pills into the region after the ban, most mislabeled as general harmless medicines.

    When contacted by AFP, the Nigerian importer for McW Healthcare was listed at a Lagos address that turned out to be a small camera repair shop with no valid pharmaceutical import permit, with Nigerian health authorities labeling all such shipments explicitly illegal. Notably, PRG Pharma’s director is a shareholder in Maiden Pharmaceuticals, the Indian company blamed by Gambian authorities for the deaths of 69 children in 2023 from contaminated cough syrup.

    Experts say the shift of Indian generic drug manufacturers to flood African markets with unapproved opioids follows decades of heavy regulation of opioid sales in wealthy nations, which have seen more than one million opioid-related deaths in the United States alone. For many low-income workers across West Africa, tapentadol is not initially used for recreational purposes: motorbike taxi drivers, market porters and artisanal gold miners take the drug to endure long hours of brutal, back-breaking labor, using it as a makeshift pain reliever and performance enhancer. Abubakar Sesay, a motorbike rider in Freetown who navigates bone-rattling unpaved backroads for a meager income, told AFP, “It energises my body to ride day and night. Without it, I can’t survive.” The pills are also used as an appetite suppressant for people who cannot afford regular meals, and even as a form of currency to pay ransoms for kidnapping victims. Criminal groups and extremist organizations including Boko Haram have also been documented using the drug to build courage for violent attacks.

    Nigeria’s National Drug Law Enforcement Agency reports that opioids are now the second most commonly used illicit drug in the country, after cannabis. The agency seized more than two billion high-strength tapentadol pills in 2023 and 2024 alone. Vanda Felbab-Brown, a senior fellow at the Brookings Institution and a leading expert on transnational opioid trafficking, told AFP that weak regulation and limited enforcement capacity in West African nations has created a permissive environment for unscrupulous Indian manufacturers. “This creates opportunities for unscrupulous Indian companies to sell products that are problematic, dangerous, harmful or outright illegal to African countries,” she said. “It’s a prime situation for trafficking networks from India to try to get people hooked.”

    A recent report from the Global Initiative Against Transnational Organized Crime found that 90% of all global tramadol seizures over the past decade have occurred in West and Central Africa. After India classified tramadol as a controlled narcotic in 2018, manufacturers simply shifted to producing and exporting tapentadol, which experts note is two to three times more potent than tramadol and far more dangerous. Today, lab testing in Sierra Leone shows that nearly all pills sold on the street as tramadol are actually unregulated high-strength tapentadol, with the similar-sounding name helping the drug slip under the radar of underfunded regulators.

    Analysis of shipment data conducted by AFP confirms that nearly 75% of all tapentadol exported to West Africa since India’s 2025 crackdown is the unapproved 225mg and 250mg dosage form. Andrew Somogyi, a professor of pharmacology at the University of Adelaide, told AFP he is not aware of any country that has approved 225mg tapentadol tablets for medical use. He questioned “why a country would want that strength except to bypass regulatory and commercial restrictions”.

    India’s national drug regulator, the Central Drugs Standard Control Organisation, told AFP it has “no record” of issuing export approvals for 225mg and 250mg tapentadol, and did not respond to repeated follow-up questions about the ongoing trade. The Indian Drug Manufacturers’ Association, the country’s leading pharmaceutical industry body, defended its members, arguing that legitimate manufacturers who follow domestic export procedures cannot be held responsible for misuse or diversion after the product leaves India. Jaydip Patel of Gujarat Pharmaceuticals told AFP the company’s exports were legal because the importer provided the required authorization letter, and added that manufacturers shifted from tramadol to tapentadol because tapentadol “is easier to export because it is not classified as a narcotic”. When AFP visited Gujarat Pharmaceuticals’ facility in Godhra in January, the building was deserted, with charred tablet fragments and ash scattered across the grounds following a recent fire. None of the other named manufacturers responded to requests for comment.

    Across the region, regulatory officials have confirmed that tapentadol of any strength is illegal in their countries. Ghana’s Food and Drugs Authority says it has never issued a permit for tapentadol importation or manufacturing, while Nigeria’s food and drug agency states that any tapentadol found in the country is unauthorised and illegal. Sierra Leone only allows 50mg tramadol to be administered in licensed health facilities, meaning all tapentadol traded on the street is explicitly banned.

    Most alarmingly, officials report the drug is now spreading to children and young adults, including primary school students who split tablets into smaller pieces to mix with energy drinks for a stronger high. In Sierra Leone, where the population still carries physical and mental scars from a decade-long civil war, informal detox centers chain addicts to beds for months to force them through cold turkey withdrawal, as the country’s limited official rehab facilities are overwhelmed. Mental health director Konneh noted that many addicts do not even recognize tapentadol as a dangerous drug, because it is packaged and sold as a legitimate medication. “The tragedy is that even addicts seeking help tell us, ‘I’ve stopped taking kush, I’m just taking tapentadol tablets.’ They don’t see that to be a problem to their health,” he said.

  • Egg sandwiches and isolation – Life in US hantavirus quarantine

    Egg sandwiches and isolation – Life in US hantavirus quarantine

    For 29-year-old photographer and content creator Jake Rosmarin, what was supposed to be a 35-day expedition cruise to some of Earth’s most isolated destinations ended in unthinkable tragedy and an unexpected 40-day quarantine in a locked medical facility in Omaha, Nebraska. On a recent Wednesday, Rosmarin whiled away the first days of his isolation by assembling a homemade egg sandwich for breakfast, using pre-ordered ingredients pulled from a numbered menu provided to all the quarantined passengers at the National Quarantine Unit.

    Rosmarin had originally planned to return home to Boston to his fiance shortly after the cruise concluded. But an outbreak of hantavirus aboard the expedition vessel MV Hondius left three passengers dead, triggering an international debate over repatriation protocols for the remaining exposed passengers and stranding the ship for days as it searched for a port willing to accept it. Today, 15 surviving passengers including Rosmarin are serving out a 40-day quarantine at the University of Nebraska Medical Center’s National Quarantine Unit – the only federally operated quarantine facility in the continental United States.

    In an interview with BBC on Wednesday, Rosmarin explained that he has settled into the quiet, constrained routine of his quarantine stay. Twice daily, a nurse clad in enhanced personal protective equipment – including medical-grade masks and face shields, though not full hazmat suits – stops at his door to check in and request a temperature reading, which has remained normal so far. When medical staff entered his room Tuesday to collect blood samples for hantavirus testing, they wore full protective gear, and followed strict decontamination protocols to change out all equipment between patient rooms. As of Wednesday morning, Rosmarin had not yet received his test results.

    To make his 40-day stay more comfortable, Rosmarin has arranged for comfort items to be delivered to his quarantine room, mixing personal orders with care packages sent by his family and fiance. He is expecting a mattress topper, new pillows, and other small items to make his basic facility room feel more like home. The first package he received contained an adult coloring book focused on inspirational quotes, though he is still waiting for a second package holding his coloring pencils to arrive. His room is already equipped with basic amenities: a private bathroom, a desk, a television, a landline telephone, and even an exercise bike to help him pass the long days of isolation.

    All quarantined passengers pre-order their meals 24 hours in advance via the facility’s fixed menu, selecting items by their number on the list. For the Wednesday breakfast when he spoke to reporters, Rosmarin combined a la carte menu items to build his own breakfast sandwich, pairing scrambled eggs, bacon, and an English muffin with hot coffee and vanilla almond milk.

    Throughout the entire outbreak, which began unfolding in the final days of the cruise, Rosmarin has shared regular updates about his experience on his social media channels – a choice he says has helped him manage his mental health through the crisis. His first posts, shared while the ship was still stranded at sea looking for a port, were raw and emotional, as he struggled with fear and uncertainty about the outbreak. Since arriving in Omaha, however, his posts and his overall outlook have become much calmer, he says.

    “On the ship, every day I felt like I was trapped in a nightmare that I couldn’t wake up from,” Rosmarin told the BBC. “It still hasn’t fully hit me what we’ve been through, but I’m in a much better headspace now that I’m here in quarantine.”

    As a content creator who builds his public life around sharing experiences online, Rosmarin says continuing to post has felt like a natural way to process the event, and public response has shifted over time. While he initially faced criticism, conspiracy theories, and even hate speech from online commenters – some of whom accused him of being selfish for pushing to disembark the stricken ship – many of those early critics have since reached out with messages of support. That outpouring of genuine public care, he says, is what got him through the most terrifying seven days of the crisis while the ship was stranded.

    The outbreak was announced to passengers less than a day before they were scheduled to disembark, Rosmarin recalled. After the captain called all passengers to a lounge to share news of the first hantavirus case, Rosmarin and many other passengers immediately retreated to their cabins, and did not leave until the ship was finally cleared to dock. For days, the ship was stuck at sea with seriously ill passengers on board, as ports around the region refused to accept the vessel, leaving the exposed passengers in limbo with no way to test for the virus or get ill passengers medical care. Rosmarin called that period “really sticky, tough and scary.”

    The turning point, he says, was finally stepping off the ship. “It was an overwhelming wave of emotion – I cried,” he said. “It really felt like we were finally being saved.” The journey to Omaha was still intimidating: he recalled being shocked by the sight of emergency personnel clad in full hazmat suits processing passengers off the ship, and felt nervous about the travel to Nebraska. But once he settled into his quarantine room, he says it was the most mentally calm he has felt since the outbreak was first announced.

    The current arrangement for the American passengers sees 15 quarantined, asymptomatic passengers staying at the National Quarantine Unit in Omaha. One additional American passenger – Dr. Stephen Kornfeld, who provided emergency medical care to ill passengers while on the ship – has tested positive for hantavirus and is currently isolating in a nearby biocontainment unit. Two more American passengers were transferred to a biocontainment unit at Emory University in Atlanta for care.

    Looking ahead to the remaining weeks of quarantine, Rosmarin says he plans to start writing about his experience to preserve the memory, so he can share the full story with his children someday. He also keeps in regular contact with his fiance, family, and other quarantined passengers staying at the Omaha facility, to stay connected while isolated.