By Rose Hoban
As the world has waited with bated breath to see if the small outbreak of the hantavirus aboard a cruise ship would multiply and spread beyond borders — another infectious disease crisis vaulted into worldview.
Last Friday, the Africa CDC confirmed a new Ebola outbreak centered in the Democratic Republic of Congo. The World Health Organization quickly declared the epidemic a public health emergency of international concern. The strain of Ebola, Bundibugyo, is a different variant from the one in the massive 2014 outbreak. That difference complicated detection of the virus, because early test results using tools geared to that 2014 strain came back negative.
As of Saturday, 246 suspected cases and 80 suspected deaths were reported in Ituri Province of the Democratic Republic of the Congo. The response in that province, the center of the outbreak, has been criticized as lacking, with health officials being slow to report the concerning symptoms and a lag in dispatching test samples to Kinshasa, the capital, according to The New York Times. Across the border in Uganda, two laboratory cases and one death have been reported with “no apparent link to each other,” according to WHO.
Health officials suspect the outbreak has been going on for much longer, noting unusual clusters of community deaths with symptoms compatible with this strain. There also have been at least four deaths among healthcare workers in a clinical context, which has raised concerns about transmission in a healthcare setting and gaps in infection prevention and control measures. Those concerns are all amplified by the ease of travel between countries surrounding the initial outbreak.
While the World Health Organization and associated global health entities mount a response — the United States is noticeably absent. The second Trump administration announced its withdrawal from WHO in January 2025, citing “mishandling of the COVID-19 pandemic” and failure to reform.
The global health infrastructure — and the relationships among the agencies and nations that shaped responses to previous global health emergencies — has changed dramatically, as has the role of the U.S. Centers for Disease Control and Prevention.
For North Carolina clinicians and researchers who worked through the 2014 Ebola epidemic, today’s outbreak raises familiar concerns but in a markedly different global health landscape. Among them is David Wohl, a UNC Chapel Hill infectious disease physician whose work on Ebola in Liberia grew out of decades spent studying emerging infectious diseases.
This interview has been edited for length and clarity.
NCHN: What do we know about this current outbreak?
David Wohl: There’s quite a bit that we’re finding out, and none of it is really good news. There has been an ongoing outbreak of Ebola with a strain called Bundibugyo.
It’s caused outbreaks in the Democratic Republic of Congo before, but it is not the same variant or strain that caused a big outbreak in 2014. That matters because the diagnostic tests that are used don’t pick up this other strain of Ebola that is now circulating in DRC. That contributed to delays in diagnosis, recognition and response, which allowed the virus to continue to spread really widely with people moving from the Democratic Republic of Congo.
Since it started in the rural area of the DRC, then people went to seek care in the capital Kinshasa, and then to Uganda nearby, and its capital Kampala. This has become a rural spreading virus that now has been transported into cities with healthcare workers getting infected, probably also now in South Sudan, which raised a whole bunch of other issues.
We’re talking about a region of the world where there’s not a lot of resources, very rural for most of this, and where there’s also civil conflict. So none of that is good news.
NCHN: Some reports say that because there are no longer USAID people on the ground to do surveillance, it took longer to identify the outbreak. Is that true?
David Wohl: I’m sympathetic to people who are trying to imagine an alternative universe where all the resources that existed historically up until about a year and a half ago — how would that have made a difference? That’s really hard. I think it makes a difference with response, but I’m not so sure how it would have made a difference with detection.
There’s a really decentralized system in the DRC, unfortunately, especially with these rural outlying areas not having good connections to resources such as testing. Some testing was done, but I think there was not good recognition that there were people getting sick with something that looked like a serious viral hemorrhagic fever and that there were clusters. That should have set off alarms.
Maybe even if we had all the resources there, I do think it wouldn’t have made it different. But I do think now when you really do need to mount a response to try to contain what should have been contained already is getting very messy — that’s where you want those resources and a deep bench of people, both here and there, to be able to respond. That is my concern, is that we are more of a skeleton crew than ever before.
NCHN: In the past, people like you and (UNC Chapel Hill infectious disease physician) Billy Fisher have responded to these health emergencies because you were part of the CDC response teams. Do those still exist, and will they be able to help with a response? The United States is also no longer a member of the World Health Organization. How are all these changes going to affect response?
David Wohl: From my vantage point, I see that the opportunities — for collaboration, for data sharing, for really being around the same table — are no longer the same as they were before. That worries me. I think when you have a global threat like this, you really do want trust and good relationships. I worry that we don’t have that to the same degree we did before, and that’s been very, very well voiced by this administration that we don’t need to do that.
That’s not to say that people aren’t talking to each other. I’m sure they are, but I do worry that again without the experienced people who were part of this not present any longer, we’re at a disadvantage. Are we stronger now to respond than we were before? I don’t think we could really say that, and I do worry that there’s diminished ability to do something that we were able to do before.
That said, domestically Billy Fisher and myself co-lead one of 13 federally funded regional emerging pathogen response centers. These are designated centers to be the end of the road. After you get the patient who has Ebola or another serious infection, they come to our center, we care for them. We’re training. We are funded to be able to respond if there’s a need, and that would include a repatriated American who has Ebola or suspected. It could include someone with hantavirus. We are being very, very aware and alert of the situation, we’re having constant meetings and I think that system remains strong.
There’s been chaos, there’s been confusion with everything, but we’re still able to function and are. All of us across the country have a sense of alert here that if we’re needed, we will be available to be called upon to do what we need to do to help Americans who might be ill.
NCHN: The administration has put in a travel ban from DRC, South Sudan and Uganda. Is that enough to stop cases from coming into the states?
David Wohl: Probably not.
I’m not even sure how effective that is. Remember those travel bans are for people who don’t have a U.S. passport. I don’t think the virus cares whether you have a U.S. passport. If you have a U.S. passport and come from these countries, you can be allowed in. I’m not sure that the travel bans will be as effective as on a local level.
Given the situation, we’re asking people when they check in for their appointments or come to the emergency room: “Have you traveled to these countries? Are you having any symptoms?” That’s part of a routine travel screen that we adjust based upon where there’s hot spots across the country, so there’ll be less people, maybe, coming from those countries that we have to screen.
NCHN: Someone could be in the affected area and then travel to, say, Ethiopia or something and then fly to the U.S. from there?
David Wohl: There’s holes in this system, but even if you absolutely were able to stop every single person coming from these countries in the United States, a chain of transmission could be such that it can come in with somebody else. The vast, vast, vast majority of people who will be traveling through our country would not have been exposed. It’s a big, big sledgehammer. I think it may make some pragmatic sense to people and may look good, but I’m not so sure how effective it will be. It can be very disruptive to a lot of people — and to even our relationships with these countries. And with personnel transfer, we want there to be a fluid transfer of people who can help respond, so we don’t want obstacles placed.
NCHN: How is Ebola transmitted, through blood and bodily fluids?
David Wohl: That’s what really makes it very … it’s a scary virus. But that’s what makes it different. A lot of us are scared when you hear about these emerging pathogens, when you hear about something like a bird flu that is transmitted by air, that is really to me much more of a concern because you could be close to somebody but not touch them and get infected.
With Ebola, you really do have to be in physical contact with them or their fluids. It’s not transmitted through the air, so while it’s a devastating infection, it is harder to catch. We always want to worry a little bit. I think with hantavirus, there’s a potential that these people who got off the boat could secondarily spread it to other people. I think there’s some really good reasons to be watching those folks carefully. But with Ebola I’m less worried about secondary spread. I’m not really seeing that happen in the United States. We’re so different than Africa, as far as that’s concerned.
NCHN: Looking at these two outbreaks, hantavirus and then Ebola virus, it speaks about the need for ongoing surveillance. What is the worldwide status of our public health surveillance system?
David Wohl: Personally, I can’t say that we’re stronger, and there’s good arguments to say we’re weaker: … We have fewer staff, when we have people who were in divisions of the CDC that were dedicated to emerging pathogens that don’t exist anymore.
You can’t tell me that makes us stronger. When we hear a lot of discussion about chronic diseases, nutrition and environmental health toxins, and to some extent say, “you really should be turning our back away from the focus on infectious diseases and emerging pathogens.” This shows us why we need to do both.
This is not just coincidence. This is not just bad luck. This is going to happen; this is predictable. We know that emerging pathogens are happening more frequently, that they’re getting more serious and their scope is widening. If anything, we should be strengthening, right now, our surveillance systems as climate change, urbanization, migration, civil conflict, all these things predispose to emerging pathogen outbreaks. We should be doubling an investment in our efforts, because these things hit us too.
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