Ebola's Hidden Crisis: Why Children Are Excluded From Life-Saving Treatments

In the Democratic Republic of Congo, an Ebola outbreak that began in mid-May has killed more than 3,000 people. The disease itself is lethal—roughly half of those infected die. But for children under five, the mortality rate climbs above 60 percent, and the culprit is not always the virus. It is often the absence of medicines designed for their bodies, and the systems that decide which patients get studied first.

The current outbreak involves the Bundibugyo Ebola virus strain. In July, researchers launched the EBO-PEP study to test an experimental antiviral drug called obeldesivir, designed to protect people exposed to the virus. The study excluded children weighing less than 30 kilograms—roughly 12 years old or younger. Protocols may soon expand to include children over 20 kilograms, but those under that threshold, typically six years old or younger, remain outside the trial entirely. For them, the alternative is remdesivir, an antiviral given intravenously. A full course requires ten days of infusions, a logistical nightmare during an outbreak, particularly with young children who cannot sit still or cooperate with repeated needle insertions.

Doctors Without Borders published a commentary in The Lancet in early September calling for children to be centered in Ebola research and prevention. The organization's argument is straightforward: children are not simply small adults. Their metabolisms work differently. They absorb and process medications differently. A dose that works for an adult cannot be scaled down without separate clinical study. Children may need liquid formulations instead of tablets. They may need different dosing schedules. All of this requires additional research, additional cost, and additional time. Pharmaceutical companies and research institutions often treat pediatric studies as a lower priority. It is faster and cheaper to focus on adults first, then add children later—if at all.

Neal Russell, a pediatric doctor in London who consults for Doctors Without Borders and led the Lancet commentary, points to the particular vulnerability of young Ebola patients. Their immune systems are weaker. Underlying health conditions are more common. Diagnosis is harder because early symptoms mimic other illnesses, and young children struggle to describe what they feel. Treatment itself is more demanding. Children require closer monitoring and specially trained staff. Many cannot be accompanied by parents or caregivers into treatment centers, which slows recovery. These are not failures of individual hospitals or doctors. They are structural gaps in how medical research is designed.

In May, an American doctor contracted Bundibugyo Ebola while treating patients in the DRC. He was flown to Berlin's Charite hospital. His wife and four children were considered at high risk after close contact with him. The medical team decided to treat the family prophylactically with an experimental antibody drug called MBP134. Han Ngoc Le, a doctor at Charite involved in the treatment, acknowledged the uncertainty. Data on the drug's effects in children was minimal. But the children faced a known, fatal threat. The family remained healthy, with no apparent side effects. Whether the experimental treatment prevented infection remains unclear—a sample of four cannot be generalized. Yet the finding mattered: the antibody was well tolerated even in one-year-olds and children under twelve. That tolerance is a foundation for future research.

The gap in pediatric medicine is not new and not limited to Ebola. In 2024, an mpox epidemic swept the Democratic Republic of Congo, and children made up a large share of the infected and dead. A vaccine existed, but it was not formulated for children. The WHO advised using it off-label for minors, but children received it later than adults. Similar patterns have emerged with HIV, tuberculosis, and COVID-19. In 2020, the Global Accelerator for Pediatric Formulations network was founded, supported by the World Health Organization, to speed the development of child-friendly medicines worldwide. The network exists because the problem persists.

Russell frames the dilemma clearly: in non-emergency research, protecting children and pregnant women from potential harm of an experimental drug makes sense. In an emergency, the calculation shifts. The risk of the disease itself becomes the competing harm. When a virus is killing children at rates above 60 percent, excluding them from trials that might save them is itself a harm. Marc Biot, access coordinator for Europe at Doctors Without Borders, calls for children and pregnant women to be included in clinical trials from the start, not added as an afterthought. Le agrees. She argues that sub-studies or parallel studies should be designed into trials from inception, not bolted on later. Russell's plea is direct: all people should benefit equally from scientific progress during a health crisis. The most vulnerable should not be last in line. No matter who you are, he says, you should have the same opportunity to access medical products that might save your life.