From Ebola response to adaptable preparedness beyond a single virus

Abstract

The Democratic Republic of the Congo (DRC) has been an important setting for Ebola innovation, including ring vaccination with recombinant vesicular stomatitis virus-based Ebola vaccine and the integration of clinical research into emergency response. These advances strengthened preparedness for Zaire ebolavirus (EBOV), but the 2026 Bundibugyo virus disease (BVD) outbreak highlights a remaining limitation: many preparedness capabilities remain closely linked to individual pathogens. Unlike EBOV, Bundibugyo virus (BDBV) has no licensed vaccine specifically indicated for prevention, and current evidence is insufficient to establish clinically meaningful protection from Ervebo against BVD in humans. Operational constraints documented in the current response, including a temporary Ervebo stock-out, limited mobility for vaccination teams, absent vaccination microplans, shortages of personal protective equipment, and gaps in triage and isolation capacity in the Bas-Uélé province, further illustrate that biomedical tools alone cannot ensure effective outbreak control. We propose extending pathogen-specific preparedness through adaptable, platform-based outbreak infrastructure encompassing four linked domains: scientific readiness, research and regulatory readiness, operational readiness, and community readiness. Such platforms should enable rapid evidence generation while retaining pathogen-specific diagnostics, clinical management, vaccines, and epidemiological knowledge. Global preparedness should therefore support transition from uncertainty to evidence and equitable action before transmission outpaces response capacity.