Dr. Joanne Liu is a Canadian pediatric emergency physician and the Director of the Pandemic and Emergency Readiness Lab (PERL). She was at the helm of Médecins Sans Frontières as the International President from 2013 to 2019, during which the organization played a key role in the response to the 2014-2016 West Africa Ebola Outbreak.
With the 2026 Bundibugyo Ebola Outbreak in the Democratic Republic of Congo now outpacing the 2018-2020 North Kivu outbreak, we asked Dr. Liu to walk us through where things stand: why containment has been harder, the challenges being faced on the ground, and her thoughts on what’s needed next. This conversation builds on and draws from a Le Devoir op-ed that Dr. Liu published on August 1st, where she discusses the outbreak [1].
The Current Bottlenecks
Q: The current 2026 Bundibugyo Ebola outbreak in the Democratic Republic of Congo has become the second largest. As of August 7th, there have been nearly ~4,053 confirmed cases, and ~1,850 deaths have been reported [2]. By comparison, the 2018 to 2020 outbreak in DRC’s North Kivu resulted in 2,687 cases in its first year [3]. What has changed, and why has containment and early isolation proved to be so difficult? What are some of the key bottlenecks?
A: Several things are happening at once, and they compound each other.
Part of what looks like an explosion in cases is actually an increased capacity to detect them. Testing capacity in the region jumped tenfold in July, from 200 to 2,000 tests a day — so some of this surge reflects better diagnosis, not necessarily a proportional increase in transmission.
But the rest is real. The Bundibugyo strain behaves differently from the Zaire strain we’re more used to: symptom development is slower, leading to later care-seeking and unknowingly spreading the virus in one’s community for several extra days. It’s been nicknamed “Walking Ebola.” And its lethality is known to be estimated slightly less than Zaire, around 30 to 40 percent. That being said, over the last few days, it has disturbingly climbed up to 45% [4].
Trust of the population in the Ebola response is a deep issue. The narrative isn’t identical to 2018–2019, when communities openly talked about the “Ebola business” for the funding it brought in the region, but where little of this wealth seemed to change the tough reality of the local communities. Hence, it fed mistrust, and this underlying mistrust toward the Ebola response hasn’t gone away, and it’s just showing up. We’re seeing vehicles stoned and roughly a dozen treatment centers attacked. In addition, healthcare worker strikes, which are not due to lack of funding, but rather over unresolved pay disputes and delayed payments to the very people risking their lives on the front line.
On top of all that is chronic insecurity. Dozens of armed groups are fighting over mineral wealth in this region, and that violence blocks access to treatment centers, toprimary care, and to the mobile teams trying to reach the communities that need them most.
The result: on average, 80 percent of newly diagnosed cases are not linked to any known chains of transmission, and even in the best-covered regions, teams are only tracing 70 to 80 percent of contacts. That’s some of the stories behind why this outbreak is outrunning the response.
Vaccines & Local Trust
Q: In a post-COVID-19 context, there has been a rising stigma linked to treatments like ring vaccination [5]. How has this increase in skepticism around medical interventions challenged responders’ efforts to build trust?
A: I’d gently push back on the framing here. There are currently no approved vaccines and no vaccination campaign underway for this strain, so there isn’t a vaccine stigma issue in play right now. What is happening is a clinical trial testing whether the existing rVSV Ebola Zaire vaccine and an experimental Ebola Sudan vaccine offer any cross-protection — this is being offered to healthcare workers under informed consent, while a Bundibugyo-specific vaccine is being developed. In addition, ChAdOx1 BDBV (Oxford/Serum Institute of India) and mRNA-1469 from Moderna have both started their phase 1 trial. We are still a long way from starting to vaccinate to protect against the Bundibugyo Ebola virus.
Infection Prevention and Control Gaps
Q: Research on the 2014–2016 Western Africa Ebola outbreak shows that transmission to healthcare workers can drive a significant proportion of early-wave infections due to inadequate infection prevention and control (IPC) in non-Ebola treatment units [6]. What do we know currently about the transmissions and IPC interventions in other healthcare facilities?
A: We don’t have solid data yet on infection prevention and control specifically in non-Ebola facilities. What we do know is troubling: some health centers have reported not having enough protective equipment for staff, treatment centers are full or over capacity, and healthcare workers are getting infected at a significant rate — 123 cases and 37 deaths among staff so far. Taken together, those points point to a real IPC gap, even if we can’t yet say precisely where it’s failing.
Understanding Concurrent Crises
Q: We know that Ebola outbreaks cause disruption in routine medical care in affected regions [7]. Can you illustrate what is currently happening to routine care, such as treatment for malaria and maternal care, in the affected regions?
A: Access to health centers is a problem for the general population, full stop. And staffing is becoming its own crisis: with more than 123 healthcare workers infected and 37 dead from Ebola, facilities are losing the people who deliver everything else — vaccination, malaria treatment, sexual and reproductive health care, nutrition support, treatment for common infections.
This is not a side issue. Keeping routine healthcare running is just as critical to saving lives as containing the outbreak itself. We urgently need to address shortages of essential medicines — PEP kits, SRH commodities, vaccines, and antimalarials. And the funding picture is making this harder: recent World Bank suspensions of health programs, combined with broader bilateral funding cuts, are already weakening essential services. The Global Fund’s recent de-prioritization of Ituri, North Kivu, and South Kivu — particularly for malaria prevention — adds even more pressure to an already overstretched system. That said, we do welcome the Global Fund’s plan to move ahead with mass drug administration in the hardest-hit health zones in Ituri. But overall, shrinking global health funding is undermining the very detection and response capacity we need to contain outbreaks like this one effectively.
Looking Forward
Q: If you could prioritize a few critical interventions for the next month to turn the tide of this outbreak, what would they be?
A: Sharpen the fundamentals: testing, contact tracing, isolation, and treatment — backed by strong IEC, information, education, and communication, on Ebola.
Test, test, and test again. A declining test-positivity rate would tell us we’re finally getting the upper hand. Right now, 80 percent of newly diagnosed cases have no known link to a transmission chain — and that is not good at all.
Trace contacts as thoroughly as possible, so we can isolate them and break the chain of transmission before it spreads further.
Isolate and treat people with dignity — including access to research trials for those who want that option.
Ensure safe and dignified burials for everyone, without exception.
And don’t lose sight of the science moving forward.
Finally — and this matters as much as any of the sciences — the world needs to commit to equitable access to whatever treatments and vaccines come out of this. Not just for those who can pay.
*This interview was conducted on August 3rd and edited/updated on August 5th and 7th, 2026, via email correspondence. This interview has been edited for length and clarity. Dr. Liu’s responses drew on an analysis she first published in a Le Devoir op-ed on August 1st, adapted here for this Q&A.