Second meeting of the IHR Emergency Committee on the epidemic of Ebola Bundibugyo virus disease in the Democratic Republic of the Congo – Meeting report

The Director-General (DG) of the World Health Organization (WHO) is hereby transmitting the report of the second meeting of the International Health Regulations (2005) (IHR) Emergency Committee (Committee) regarding the epidemic of Ebola disease caused by Bundibugyo virus (BVD) in the Democratic Republic of the Congo (DRC), held on Tuesday, 18 August 2026, from 12:00 to 17:00 CEST.

The DG welcomes the Statement by the Committee, presented at the beginning of its report, and expresses his most sincere gratitude to the Chair, Members, and Advisors of the Committee.

Concurring with the advice expressed by the Committee during the meeting, the DG determined that the BVD epidemic in the DRC continues to meet the criteria of a public health emergency of international concern (PHEIC), but not those of a pandemic emergency. Accordingly, on 24 August 2026, the DG, considering the advice offered by the Committee, issued temporary recommendations to States Parties, available here.  

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Statement by Committee

The Committee commends the Government of Uganda for the rapid control of BVD transmission, with no new cases detected since 16 July 2026, and recognizes the major efforts being undertaken by the DRC, affected communities, WHO and national and international partners. Nevertheless, the Committee considers the continuing rapid growth and geographic expansion of the epidemic in the DRC to be of grave concern, requiring urgent, intensified and sustained action.

As of 18 August 2026, approximately 5,000 BVD cases have been reported in the DRC. Available modelling suggests that substantial under-ascertainment may be occurring, with the true number of infections potentially three- to four-fold higher. Without a rapid change in the trajectory of transmission, the epidemic risks reaching a scale with profound national and regional consequences, with the potential for case numbers and deaths to exceed those seen in the 2013-2016 Ebola disease epidemic in West Africa. The Committee therefore emphasizes the need for urgent, decisive and coordinated action to control BVD transmission in the DRC.

The BVD epidemic is occurring in the context of an already severe and complex humanitarian emergency. Areas with some of the highest BVD transmission burdens substantially overlap with areas affected by armed conflict, insecurity, population displacement and constrained humanitarian access.

These conditions endanger affected populations and responders, impede community engagement, surveillance, contact tracing, safe and timely access to care, infection prevention and control (IPC), and other essential response operations.

At the same time, disruption of essential health services risks increasing preventable deaths from malaria, diarrhoeal diseases, maternal causes and other conditions. Uncontrolled transmission also carries potentially serious consequences for neighbouring countries and for the social and economic stability of the Great Lakes region.

The Committee emphasizes that communities must be at the center of the response. Erosion of trust in authorities and responders, insufficient community ownership, insecurity and operational and coordination weaknesses are major impediments to effective control. These challenges cannot be addressed through public health interventions alone. The response must be built with affected communities and supported by trusted local leaders and organizations, with transparent communication, meaningful participation and mechanisms through which community concerns rapidly influence response operations.

The Committee notes that current epidemiological, clinical and genomic evidence does not indicate a fundamental change in the known biology, modes of transmission or clinical characteristics of Bundibugyo virus (BDBV). The priority, therefore, is to deliver science-based public health response interventions of proven effectiveness at sufficient speed, quality, coverage and scale.

The Committee is deeply concerned that implementation of core essential public health response interventions has not yet consistently achieved the coverage and performance required to interrupt BVD transmission. An immediate and drastic operational intensification and scale-up of response operations is required, potentially with an operational reset. Particular priority needs to be given to ensuring community engagement and community-based surveillance; rapid case detection, investigation and isolation; comprehensive contact identification and follow-up; IPC in BVD isolation and treatment centers, other health-care facilities and communities; safe and dignified management of deaths; timely laboratory diagnosis; and accessible, high-quality clinical care. All these areas require intensification of efforts, and all should be viewed as essential components of an effective response. While none of these areas can afford to be neglected or deprioritized, the Committee identifies below specific areas requiring urgent action and particular focus.

Effective vaccines and therapeutics against BVD, should they become available and be demonstrated to be safe and effective through rigorous clinical trials, could make an important contribution to reducing transmission, morbidity and mortality; however, they should complement rather than be a substitute for rigorous implementation of core public health measures.

The response must be planned not only for the immediate term but for the sustained engagement that will be required over the coming months, or even years. This requires predictable financing, adequate human resources, secure access to communities, resilient supply chains, continuity of essential health services, and sustained national, regional and international political commitment.

The Committee therefore calls for an immediate, unified and fully resourced intensification of the response, under the leadership of the Government of the DRC and with sustained regional and international support. The temporary recommendations issued by the DG should be translated into one integrated, time-bound and costed national action plan for the DRC, serving as the common framework for aligning the efforts and resources of the Government and national and international partners.

The plan should establish clear responsibilities, measurable milestones and indicators; identify operational and geographic gaps; quantify the human, logistical and financial resources required; and include a companion gap analysis to guide urgent resource mobilization. Implementation should be reviewed frequently against agreed indicators and the evolving epidemiological situation, with rapid corrective action where milestones are not being achieved.

Given the intersection between ongoing transmission, armed conflict, insecurity and restricted humanitarian access, the Committee emphasizes that high-level political engagement is urgently required to secure safe, sustained and unhindered access for epidemic-control operations that is being called for. National, regional and international leaders should use all appropriate diplomatic and humanitarian channels to create the conditions necessary for effective implementation of comprehensive response measures. Where required, this should include arrangements for temporary cessations of hostilities or other humanitarian access measures that enable affected communities to receive essential health services and allow response teams to operate safely and effectively.

The imperative is clear: interrupt BVD transmission rapidly, protect affected communities and health workers, maintain essential health services, prevent further geographic and cross-border spread, and mobilize the political, operational and financial support necessary to bring the epidemic under control.

The Committee calls for particular focus on the following urgent priority interventions:

• Drastic scale-up of trust-building and community engagement through trusted communication channels and local actors, including local leaders, religious leaders, traditional healers and survivors, to support community participation in fostering the acceptance of public health measures, including early detection, case referral, contact tracing, safe and dignified burial practices, and adoption of protective behaviours.
• Drastic scale-up of IPC measures to prevent transmission in BVD isolation and treatment centers, other healthcare settings, and, in some circumstances, at home in the community. With regard to the latter, although it is not realistic to expect community members to be able to maintain the same level of application of IPC measures as in healthcare settings, it must be recognized that, for myriad reasons, many sick persons cannot or will not seek care in health care facilities. Until clinical care capacity can be augmented, along with the requisite enhanced security and community trust to motivate and permit sick persons to seek care, steps to limit transmission in the home, such as distribution of personal protective equipment, materials and disinfectants, may reduce transmission risk and morbidity, and may also represent a conduit for greater community engagement.
• Drastic scale-up of BVD isolation and treatment centers staffed by a specifically trained workforce, with appropriate provision of personal protective equipment and materials.

In-depth analysis or research to identify and characterize BVD transmission dynamics associated with specific settings, including related modes of BVD transmission (e.g. caretaking in the home, hospital, or at traditional healers, re-use of needles). A better understanding of the epidemiology of the epidemic is essential for the implementation of effective interventions.

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The Annex to this Report records the views of one Member of the Committee in relation to the “Statement by the Committee”.

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Proceedings of the meeting

All 12 Members of, and five Advisors to, the Committee participated in the meeting convened by teleconference, via Zoom, on Tuesday, 18 August 2026, from 12:00 to 17:00 CEST.

The DG joined in person and welcomed the participants, including Government Officials designated to present their views to the Committee on behalf of the three invited States Parties – the DRC, France and Uganda. The opening remarks by the DG are available here.

The Representative of the Office of Legal Counsel briefed the Members and Advisors on their roles and responsibilities and identified the mandate of the Committee under the relevant provisions of the IHR. The Ethics Officer from the Department of Compliance, Risk Management, and Ethics proceeded with the rollcall and provided the Members and Advisors with an overview of the WHO Declaration of Interests process. The Members and Advisors were made aware of their individual responsibility to disclose to WHO, in a timely manner, any interests of a personal, professional, financial, intellectual or commercial nature that may give rise to a perceived or actual conflict of interest. They were additionally reminded of their duty to maintain the confidentiality of the meeting discussions and the work of the Committee. Each Member and Advisor was surveyed, with no conflicts of interest identified.

The meeting was handed over to the Chair who introduced the objectives of the meeting, which were to provide views to the DG on whether the event continues to constitute a PHEIC, including a pandemic emergency, and to provide views on the proposed temporary recommendations.

Session open to representatives of States Parties invited to present their views

Representatives of the DRC and Uganda updated the Committee on the BVD epidemiological situation in their countries, their current response efforts, needs and challenges. Ahead of the meeting, France submitted a written statement to the Committee regarding an imported BVD confirmed case from the DRC.

The WHO Secretariat presented a comparative assessment of the indicators associated with each of the three criteria defining a PHEIC between 17 May 2026, when the PHEIC was determined, and 12 August 2026, as well as the indicators associated with each of the criteria defining a pandemic emergency, as per Article 1 – Definitions of the IHR. The WHO Secretariat also presented an overview of health operations and the scale up strategy in response to the BVD epidemic.

With respect to the indicators associated with the PHEIC criteria, the following assessment was presented.

1. Extraordinary

1.1. Growth rate (effective reproductive number (Rt))

On 17 May 2026, the growth rate could not be calculated, though it was understood to be very high, given the orders-of-magnitude increase in the number of confirmed cases since then. Case-based estimates now suggest a doubling time of 52 days and an Rt of 1.24; however, low case ascertainment means these figures are likely to understate true transmission. Deaths are considered a more reliable indicator of epidemic growth, given higher relative ascertainment of fatal outcomes. Based on mortality data, the estimated doubling time is 21 days, with an Rt of 1.55. Triangulation across multiple methods and data sources further estimates that the true size of the epidemic is 3 to 4 times larger than what is reflected by surveillance data. Growth rate was assessed as ‘very high’ at the time the PHEIC was determined and continues to be assessed as ‘very high’ as of 12 August 2026, with confidence improving from ‘low’ to ‘moderate.’

1.2. Within country geographical spread (number of health zones with BVD in the DRC)

On 17 May 2026, BDBV was known to be present in three health zones in the DRC. As of 12 August 2026, its presence had expanded to 55 health zones, 49 of which had active transmission. The geographic mapping of confirmed BVD cases likely understates the real extent of the spread, as some affected areas remain outside government control or are subject to insecurity limiting surveillance and response operations. Forecasting identifies 15 health zones at highest risk of further expansion in the coming week, four of which border Uganda, South Sudan, and Rwanda. The indicator increased from ‘moderate’ on 17 May 2026 to ‘high’ on 12 August 2026, with the level of confidence remaining ‘moderate’.

1.3. Challenges to contact tracing (proportion of BVD cases from listed contacts)

Challenges with contact tracing persist unchanged. While the follow-up of listed contacts stands at approximately 80%, the average of 13 listed contacts per BVD case is far lower than that observed in previous viral hemorrhagic fever outbreaks. This results in only approximately 20% of BVD cases being identified through the follow up of listed contacts, and 40% of the BVD cases eventually linked to a chain of transmission. Challenges to contact tracing were assessed as ‘very high’ on 17 May 2026 and they remained ‘very high’ as of 12 August 2026. The level of confidence of those assessments moved from ‘low’ (17 May 2026) to ‘moderate’ (12 August 2026).

1.4. Severity (case fatality ratio (CFR))

Early in the epidemic (around mid-May 2026), the crude CFR appeared as low as 20%, as the numerator did not include several deaths among persons under investigation for suspected BVD. As surveillance improved, as of 12 August 2026, the crude CFR stands at approximately 46%, notwithstanding persisting limitations in data quality. As expected, the CFR varies by age, with no meaningful difference observed by sex. The assessment of the severity as ‘high’ remained unchanged between 17 May and 12 August 2026, with the level of confidence moving from ‘low’ to ‘moderate.’

1.5. Disruption to health services (various)

Before the BVD epidemic was detected, health services in the areas with current BVD transmission were already under strain from a deteriorating humanitarian situation, compounded by funding withdrawals, attacks on healthcare facilities, and supply chain disruptions. According to the most recent assessment conducted after the BVD epidemic was detected, the use of health care services has fallen by more than 40% in some of the areas with BVD transmission. Despite that, the observed incidence of malaria, cholera, and trauma cases remain high. In Ituri Province, maternal deaths have doubled since May 2026, currently averaging more than six per week. As of 17 May 2026, the disruption to health services was assessed as ‘moderate’ and, due to its worsening, it was assessed as ‘high’ as of 12 August 2026. Due to the scarcity of data, the level of confidence in those assessments remained ‘low’ and unchanged between 17 May 2026 and 12 August 2026.

2. International spread

2.1. Number of States Parties with BVD cases (imported cases, including resulting in limited local transmission)

Historically, imported cases of Ebola virus infection have been reported during past outbreaks. However, only in a very limited number of instances have imported cases resulted in onwards transmission – limited to a very small number of cases – in States Parties outside Africa. In the context of the ongoing BVD epidemic in the DRC, modelled estimates indicate the risk of BVD spread to States Parties outside Africa remains very low. With respect to the risk of BVD spread from the DRC to other States Parties in Africa, modelled estimates indicate that this is significant for States Parties sharing land borders with provinces of the DRC with BVD transmission. Beside the possibility of reintroduction of BVD into Uganda, the risk is highest for South Sudan, reflecting its connectivity with the DRC. It is noted that the Central African Republic was not included at the time the modelled estimates were calculated.

As of 17 May 2026, two States Parties (the DRC and Uganda) had detected BVD cases, with BVD cases in Uganda resulting from importations from the DRC and limited onwards local transmission. At that time the indicator was assessed as ‘low’. As of 12 August 2026, active BVD cases were reported only in the DRC, following control of BVD transmission in Uganda. The single imported BVD case detected in France did not result in onward transmission. The assessment of this indicator therefore remains ‘low’. Between 17 May and 12 August 2026, the level of confidence moved from ‘moderate’ to ‘high.’

2.2. Gaps in preparedness in States Parties sharing land borders with the DRC (and Uganda) (composite percentage)

States Parties considered in this assessment are those sharing land borders with the DRC, as well as with Uganda, given the detection of imported BVD cases in Uganda early in the epidemic, and include Angola, Burundi, Central African Republic, Kenya, Republic of Congo, Rwanda, South Sudan, Tanzania and Zambia. In the context of quarterly readiness self-assessment, coordinated by the WHO Regional Office for Africa, a specific BVD-readiness assessment was conducted in the third quarter of 2026. The average readiness score of that assessment, encompassing 11 readiness domains and expressed in percentage, is as follows: Central African Republic – 38%; Republic of Congo – 50%; Tanzania – 53%; Angola – 64%; South Sudan – 65%; Zambia – 70%; Rwanda – 94%. There are no data available for Burundi and Kenya. The assessment of this indicator as ‘high’ remained unchanged between 17 May and 12 August 2026, with the level of confidence remaining ‘moderate’.

3. International cooperation

3.1. In-country response capacity exceeded (expert judgement based on operational outputs and epidemiological data)

Since the BVD epidemic was detected in the DRC, the national response capacity has been scaled up. As of 12 August 2026, there were 21 laboratories with BDBV testing capacity, and approximately 1000 beds for the treatment of BVD cases. Although these figures may represent the fastest scale-up on record and reflect a very large-scale operational response, the late detection of the epidemic and the resulting unprecedented growth in BVD cases have outpaced the combined response capacity of the Government and partners. For example, the estimated number of beds needed for the treatment of BVD cases is 3000. Furthermore, there is a need to maintain essential health and humanitarian services amid severe access constraints, large-scale displacement and logistical disruptions, including the closure of the airports in Goma and Bukavu. The closure of these airports has hindered the delivery of essential supplies and led to recurrent stock-outs, further increasing the risk of morbidity and mortality. While this indicator was assessed as ‘high’ on 17 May 2026, in light of mounting humanitarian pressures, dwindling resources and the pace of epidemic growth, it was assessed as ‘very high’ on 12 August 2026, with the level of confidence remaining ‘high’.

3.2. Need for coordination of international response (expert judgement based on response operations data)

Since the BVD epidemic was detected in May 2026, a continental preparedness and response plan was developed to support the implementation of national plans and coordinate the work of more than 30 named partners, with all partner response activities coordinated under a Continental Incident Management Support Team. Under that framework, a joint financial tracking mechanism has been established. As of 12 August 2026, there were 94 partners reporting engagement in the BVD response, across multiple technical pillars, with operations concentrated in Ituri, North Kivu and South Kivu Provinces in the DRC, leaving critical gaps in partner support elsewhere in the country. The WHO Secretariat has deployed 274 staff, including through partner networks, against a target of 455. The overall need for coordination of the international response was assessed as ‘high’ on 17 May 2026, and remained such as of 12 August 2026, with the level of confidence remaining unchanged as ‘high’.

3.3. Access to BVD-specific countermeasures

As was the case when the BVD epidemic was detected in May 2026, as of 12 August 2026, no BVD-specific countermeasure is licensed. This indicator therefore remains not applicable.

Members of, and Advisors to, the Committee then engaged in questions and answers with States Parties’ Representatives and the WHO Secretariat.

Deliberative session

Following the session open to invited States Parties, the Committee reconvened in a closed session to examine the questions in relation to whether the event constitutes a PHEIC, including a pandemic emergency, and to consider the temporary recommendations drafted by the WHO Secretariat in accordance with IHR provisions.

The Chair reminded the Committee Members of their mandate and recalled the definitions of PHEIC and pandemic emergency, as per Article 1 – Definitions of the IHR.

Except for one Member, the Committee expressed the view that the BVD epidemic in the DRC continues to constitute a PHEIC but does not meet the criteria of a pandemic emergency, and that the DG be advised accordingly.

The Committee subsequently considered the temporary recommendations to States Parties proposed by the WHO Secretariat.

The Committee, ahead of its meeting, had received proposed temporary recommendations drafted by the WHO Secretariat in accordance with the provisions of the IHR, and subsequently offered its insightful advice.

Specifically, the Committee called for the formulation of temporary recommendations stressing the urgency of immediately intensifying core interventions, including a drastic operational scale-up of human resources, as well as for planning efforts to sustain the response to the BVD epidemic over a prolonged period.

Conclusions

The Executive Director of the WHO Health Emergency Preparedness and Response Programme, on behalf of the DG, expressed his gratitude to the Committee’s Officers, its Members and Advisors and closed the meeting.

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Annex

In accordance with paragraph 4.12, under Reports on Meetings of Committees in the WHO Regulations for Expert Advisory Panels and Committees, the Committee hereby records the divergent views expressed by one Member with respect to the “Statement by the Committee”.

While the Statement reflects the deep concern expressed by the other Members of the Committee in the course of formulating their advice to the Director-General on whether the event constitutes a public health emergency of international concern, one Member indicated that the Statement extends beyond the terms of reference of the Committee, as set forth in Articles 12, 17, 48 and 49 of the IHR.

The specific reasons provided by the Member relate to the following aspects addressed in the Statement: “operational management of the response, national response planning, resource allocation and mobilization, political or diplomatic engagement, or humanitarian and security arrangements.”