Ebola Again:
A Quarter-Century of Broken Promises
Dr. José M. Zuniga, President/CEO, Fast-Track Health
The Ebola outbreak unfolding across the Democratic Republic of the Congo (DRC) and Uganda is not merely another infectious disease emergency. It is another reminder that the world has learned remarkably little from the last half century of epidemic response.
Once again, headlines are filled with familiar language: cases rising, health workers mobilizing, border screenings intensified, emergency meetings convened, international concern mounting. Once again, the world is expressing surprise that a deadly pathogen has emerged in a region where health systems remain fragile, trust in institutions remains uneven, and public health infrastructure is struggling to keep pace with recurrent threats.
The current outbreak is caused by the Bundibugyo strain of Ebola virus, a less common strain for which there are no widely available approved vaccines or treatments. Public health authorities are racing to contain transmission, identify contacts, and prevent wider regional spread. The stakes are high, as they always are with Ebola. But if all we do is focus on the epidemiology, we miss the real story.
The most troubling aspect of this outbreak is not that Ebola has returned. Ebola never truly left. The troubling aspect is that the structural conditions allowing Ebola to flourish remain largely unchanged despite decades of experience, billions of dollars invested, and countless promises that the world would “never again” be caught unprepared. How many times have we heard that phrase?
After the West African Ebola epidemic of 2014-2016, the global health community pledged transformational investments in preparedness. After subsequent outbreaks in DRC, experts emphasized the importance of community trust, local surveillance, health workforce protection, and rapid response infrastructure. Following COVID-19, governments again promised to build resilient health systems capable of detecting and responding to emerging threats. Yet here we are. Again.
Health workers are confronting community mistrust. Again. Contact tracing is struggling. Again. Funding is inadequate. Again. Response systems are being stretched. Again. Public health officials are warning that the outbreak is outpacing available resources. Again. The pattern has become painfully predictable.
What if Ebola outbreaks are not primarily failures of public health? What if they are failures of governance? What if they are failures of political imagination? What if they are failures of accountability? The uncomfortable truth is that responsibility does not rest solely in Washington, Brussels, Geneva, New York, or other centers of global influence. It also rests in African capitals.
In 2001, African heads of state gathered in Abuja, Nigeria, and adopted what became known as the Abuja Declaration. They pledged to allocate at least 15% of their annual national budgets to health. The commitment was historic. It reflected an understanding that health was not a luxury or a donor-funded project, but a prerequisite for development, prosperity, and security. Twenty-five years later, that promise remains largely unfulfilled.
Only a small number of countries have consistently reached or exceeded the 15% target. Many have fallen well short. Others have made intermittent progress only to reverse course. Across much of the continent, health systems continue to operate under chronic resource constraints, relying heavily on external financing for critical functions ranging from disease surveillance to workforce support to supply chains. Yes, many of these countries are saddled with debt servicing, but that cannot be used as a blanket excuse when allocation of available budget prioritizes other national investments.
This reality matters. The current Ebola outbreak is unfolding amid growing concern about reductions in external assistance, including cuts to development aid programs and uncertainty regarding the future of global health financing. Those concerns are legitimate. The dismantling of health programs and abrupt withdrawal of funding can have devastating consequences.
But it would be intellectually dishonest to suggest that the vulnerabilities exposed by Ebola emerged because donor funding has weakened. The vulnerabilities were already there. They have been there for decades.
Too often, global health has operated as a cycle of panic and neglect. When an outbreak erupts, resources flood in. Emergency operations centers are activated. International experts arrive. Press conferences are held. Funding is mobilized. Then the outbreak subsides. Attention shifts elsewhere. Funding declines. Political urgency evaporates. And the underlying weaknesses remain.
Donors are not exempt from responsibility. For decades, international financing has favored vertical programs focused on specific diseases rather than broader investments in resilient health systems. Governments and development partners alike have often preferred measurable short-term wins over the slower, less glamorous work of strengthening primary healthcare, building public health institutions, training and retaining health workers, and establishing sustainable domestic financing mechanisms.
The result is a dangerous equilibrium in which everyone assumes someone else will solve the problem. Donors assume governments will eventually increase domestic investment. Governments assume donors will continue providing emergency support. International agencies assume coordination will compensate for systemic weaknesses. Meanwhile, outbreaks continue to expose the same fault lines.
The DRC has now experienced repeated Ebola outbreaks since the virus was first identified in 1976. At what point do we stop describing these events as recurring crises and begin describing them as symptoms of a chronic failure to address root causes?
Equally concerning is the selective attention outbreaks receive. When Ebola threatens to cross international borders, emergency meetings multiply and media coverage intensifies. When Ebola remains concentrated in African communities, concern often exceeds commitment. We witnessed this dynamic during previous Ebola outbreaks. We witnessed it during the inequitable distribution of COVID-19 vaccines. We continue to witness it today.
History is not repeating because Ebola is inevitable. History is repeating because the incentives driving public health remain largely unchanged. Preparedness is praised in speeches but underfunded in budgets. Health security is discussed as a global priority but treated as a national expense.
Moreover, community engagement is celebrated in reports but neglected in practice. Health workers are called heroes while being asked to perform miracles with insufficient resources. And political leaders continue making promises that too often outlive the news cycle rather than shaping long-term policy.
The lesson from DRC and Uganda should not simply be that Ebola remains dangerous. We already know that. The lesson should be that outbreaks reveal the true state of our priorities. They reveal whether governments are willing to invest in health before emergencies occur. They reveal whether donor nations are committed to genuine partnership rather than episodic intervention. They reveal whether the global health community values resilience as much as response. And they reveal whether we have learned anything from the countless declarations, communiqués, and pledges issued over the last quarter-century.
Ebola is not just testing the health systems of DRC and Uganda. It is testing the credibility of governments, donors, multilateral institutions, and the global health community itself. A quarter-century after the Abuja Declaration, and more than a decade after the largest Ebola epidemic in history, the world should not still be confronting the same predictable weaknesses. Yet here we are. Again.
Unless we finally confront the political and structural failures that allow these cycles to continue, the next Ebola outbreak will arrive right on schedule followed by the same declarations, the same promises, and the same collective amnesia. The virus may be different next time. The story will not.