DRC Ebola outbreak may be 3x larger than reported, Africa CDC warns

The Democratic Republic of the Congo is in the grip of an Ebola outbreak far more severe than official numbers suggest. As of mid-August, health authorities had confirmed 5,208 cases and 2,476 deaths across six provinces, with a fatality rate hovering near 48 percent. But those figures, according to Africa's top disease control agency, capture only a fraction of what is actually happening on the ground. Modeling conducted jointly by the Africa Centers for Disease Control and Prevention, the DRC's National Institute of Biomedical Research, and other partners indicates the true number of infections likely falls between 10,000 and 15,000—meaning the outbreak could be three times larger than reported.

The gap between confirmed and actual cases points to a surveillance system overwhelmed by the speed and scale of transmission. Fewer than 10 percent of detected cases are currently traced to known contacts, and fewer than 40 percent have any epidemiological link to another confirmed infection. The virus circulating in the DRC is Bundibugyo Ebola, which produces milder and less typical symptoms than the Zaire strain that devastated West Africa a decade ago. This subtlety may be working against containment efforts—people with less severe illness are less likely to seek treatment, allowing chains of transmission to continue undetected in communities. Evidence suggests the outbreak may have begun as early as February, months before it was formally declared on May 15, meaning hundreds or thousands of infections occurred in the shadows before any response was mounted.

The scale of the crisis has prompted a shift in strategy. The DRC government launched an emergency initiative Thursday aimed at preventing the Congo River—one of Central Africa's busiest transport corridors—from becoming a highway for the virus. The river carries thousands of passengers, traders, and transport operators daily toward major cities, particularly Kinshasa, a metropolis of nearly 20 million people where no confirmed cases have yet been reported. Health officials fear that undetected infections could travel long distances along the waterway before symptoms emerge, potentially seeding outbreaks in the capital and across borders into the Republic of the Congo and the Central African Republic. The "Congo River Without Ebola" initiative includes reinforced screening at ports, community early-warning networks, expanded isolation capacity in key hubs, mobile floating laboratories, and preparations for vessel quarantine. An initial three-month intensive phase will focus on equipping control points and raising awareness among riverside communities. The effort has mobilized $9 million in funding through the UN Office for the Coordination of Humanitarian Affairs.

Jean Kaseya, director-general of Africa CDC, has been blunt about the trajectory. He told Congolese media that the epidemic "is not under control" and warned that without major changes to the response, the outbreak could eventually surpass the 2014-2016 West Africa epidemic, which killed more than 11,000 people. Kyeng Mercy, an Africa CDC official, acknowledged at a press briefing that the modeling figures are estimates subject to uncertainty, but said multiple indicators consistently point to significant under-detection. "We are detecting just 30 to 40 percent," Mercy said. "If you have to look at the real burden, we should be over 10,000 to 15,000 cases."

In response, health authorities are overhauling their approach. The conventional contact-tracing model, which has proven inadequate as transmission spreads too widely to track individual cases, is being replaced by what officials call a "village-centered response." Under this strategy, village chiefs and community health workers will conduct house-to-house searches, report alerts, and link suspected cases directly to health facilities. The shift is also intended to address deep distrust of response teams that has delayed treatment and created resistance in affected communities. Vaccination is becoming a larger component of the strategy as well. An initial 70,000 doses of Ervebo vaccine—licensed against Zaire Ebola rather than the Bundibugyo strain—have been allocated to the DRC, with the first doses expected to arrive within days. Authorities plan to deploy the vaccine both for research purposes and among frontline workers and at-risk populations, betting on emerging evidence that it may offer some cross-protection against the circulating strain.

Kaseya has stressed that the current trajectory must change. "I think the population can hope that, with all the measures we are going to put in place, we will be able to stop this outbreak," he said. But the warning from Africa CDC is stark: the continent must remain on high alert, with the highest risks concentrated in East and Central Africa. The outbreak has already expanded rapidly overland, and growing transmission in the northern Bas-Uele province, near the Central African Republic border, has made cross-border surveillance increasingly urgent. What happens in the coming weeks—whether the new response strategies can bend the epidemic curve, whether the Congo River initiative can hold the line against spread toward Kinshasa, whether vaccination and village-centered approaches can finally break chains of transmission—will determine whether this outbreak becomes a regional catastrophe or a contained crisis.