This Ebola Outbreak Is a Nightmare. Are Aid Cuts to Blame?

No, the response is not being starved of money. But aid cuts may have helped this Ebola outbreak go unnoticed for too long, and money alone can’t buy what eastern DRC needs most.

If you haven’t been following this day to day, let me give you the short version: the Ebola outbreak in eastern Democratic Republic of the Congo is totally out of control.

The caveat is that “out of control” is not the same thing as “we know exactly how bad it is.” In some ways, the most frightening part is that we don’t. Officially, over 700 cases and nearly 200 deaths have been confirmed so far. But “no one knows the true scale or exactly where the disease is spreading in DRC,” Kate White, emergency medical coordinator for Doctors Without Borders, told Reuters this week.

For the clearest snapshot of the chaos, I’d recommend reading that full Reuters story. It’s hard to pinpoint what isn’t going wrong… Testing is nowhere near keeping pace with the epidemic. Treatment centers are being overwhelmed. Patients are fleeing care. Responders tasked with burying highly-infectious bodies are being attacked. And in some places, as one Congolese public health official has leaked, “people continue to die in communities without ever coming to the attention of health authorities.”

If you need a visual, watch the New York Times’ recent video with Declan Walsh from the front lines, which shows the kind of thing that makes even hardened epidemiologists shudder: people moving in and out of an active Ebola treatment center with essentially no precautions. The nightmare, of course, is that these people are not only risking contracting the disease and a therefore possibly horrific death themselves, but becoming the source of a brand new chain of infections.

And, ultimately, I think “nightmare” is the apt word for this out-of-control outbreak of Ebola’s Bundibugyo strain, for which there is still no approved vaccine.

Contrast this picture with the two other hemorrhagic fever outbreaks of late last year: which were an outbreak of Ebola’s Zaire strain in the central Kasaï Province of DRC (notably: an Ebola strain for which we have an effective vaccine) and a Marburg virus outbreak in southwestern Ethiopia (a virus that’s a near cousin of Ebola, with no vaccine). As I wrote for Healthbeat.org at the time, those emergency responses were conducted “close to best-case scenario.” The control efforts were extraordinarily rapid. And they drew on decades of hard-won lessons to contain and ultimately crush what might otherwise have become out-of-control epidemics.

Frankly, last year I was surprised. Both outbreaks emerged after a massive cut in the global funding for disease surveillance and emergency responses. (By one estimate, 2025 saw a 22% drop.) Successes—and brilliant successes at that!—were no sure thing. Yet the old machinery still seemed to work, and most importantly, the world ponied up the dollars needed.

This leads me to the obvious question: why is this outbreak so different, and is a drop in global health dollars a major factor at play?

It’s worth noting that outbreaks of disease like Ebola have a cruel, financial arithmetic to them: double the number of unidentified infections does not mean double the cost. It’s much worse than that. One missed patient might ultimately spark ten cases. Two missed patients don’t necessarily lead to twenty cases—they can lead to forty cases, as separate chains of transmission spread at the same time. Every additional uncaught case means exponentially more contacts to trace, more tests to run, and more people needing treatment. So, the cost of containing an outbreak rises faster than the outbreak itself.

So I wanted to know: is this outbreak spiraling because it has simply grown beyond what today’s weakened global health system can afford to contain? Or is the real problem something else? To help untangle that question, I spoke with Katharina Hauck, a leading health economist at Imperial College London who specializes in infectious disease economics. (She is part of the research team at Imperial College London that is collaborating with the World Health Organization on the real-time Ebola response.)

Are Aid Cuts to Blame?

Let’s start with what we know about the funding numbers, which are notoriously hard to pin down, even years after an outbreak is over. In 2021, Hauck published a paper trying to track dollar figures for Ebola and Zika outbreaks from the previous decade. The takeaway was that even after the fact, no one could quite agree on what had been spent, by whom, or on what. Our clearest picture left a half-billion dollar error range.

That uncertainty is at play now. When I asked Hauck how the current response is doing financially, she was careful not to pretend the exact dollar figures were knowable, but also stopped well short of sounding alarmist. “What has been pledged so far is not insignificant and quite substantial,” she told me. “We have hundreds of millions of U.S. dollars pledged to the response… with broader commitments suggesting between $400 million and $500 million total.” This all includes a mix of dollars for things like fast-tracking a vaccine for this Ebola strain, alongside on-the-ground testing, health centers and more.

Is that enough to meet the current moment? The short answer is: so far, mostly yes.

“Objectively, I find [the current pledges] quite a good commitment from the international community,” she told me, especially given that the World Health Organization and Africa CDC (who are the ones coordinating this response) have called for a plan from June to November 2026 with a total price tag of $518 million. (That said, Hauck notes that ‘pledged’ money can fall short of what’s ultimately disbursed.)

But she was equally clear that this does not mean the response is fully funded. Far from it. “I think much, much more funding will be necessary to contain this,” she said. Hauck points to the last major Ebola outbreak in eastern DRC, from 2018 to 2020, which caused nearly 3,500 cases and around 2,300 deaths. That outbreak cost an estimated $1.35 billion (!) to handle. And for that strain, we had the cost-reducing benefit of a functioning vaccine.

Today’s outbreak is on track to be far worse. We may be looking at something that looks much more like the world’s previous largest Ebola outbreak—the 2013 to 2016 outbreak in West Africa—which cost something on the order of $5 to $6 billion.

And Hauck reminded me that pledged money does not magically become an Ebola response. “There’s one thing of having funding going into the country,” she said, “but it’s another for that funding to actually make a difference on the ground.”

As she explains, the main cost in public health responses like an Ebola outbreak is ultimately people. “You need a trained workforce,” Hauck told me. “Often 70 or 80 percent of the costs are staff. You can’t overemphasize how important it is to have the staffing there.” And of course, money alone does not instantly summon trained professionals who know how to trace contacts, or convince a skeptical town to let them run safe burials, or generally manage in one of the most difficult places on earth to stop a virus.

But my big takeaway here: currently, aid funding constraints are not the driving force behind this outbreak’s downward spiral.

Ok, ok. So what is the issue?

Well, one potential answer actually is… aid cuts, just not in the reactive way we just covered.

Hauck points out that past Ebola responses in places like eastern DRC relied heavily on American foreign aid, and benefited from (the now-defunct) USAID’s deep networks of local partners already working on the ground. These were organizations that knew the communities and the health system, worked to cultivate some level of standing community trust, and could pivot fast when something strange began happening.

Today “this whole outbreak happened in a scenario where all this had been basically cut,” Hauck said. That matters because this outbreak appears to have been caught shockingly late. We’re not sure how late, exactly, but it looks like Ebola may have been spreading for over a month or more before the alarm was raised.

“I think it’s very surprising that this outbreak was detected so late,” she said. “Even if there was a cluster of unusual hemorrhagic fever which didn’t test as Ebola, major alarms should have gone off.”

Why? Well, one answer may be that aid cuts weakened the aid partner networks, clinics and surveillance systems that notice a pattern of strange deaths before they become a full-blown epidemic. But, to be clear, this is speculation. Would someone in the old system have alerted upward faster about a strange, undetected cluster of deaths? We do not know the answer yet, and may not until investigators reconstruct the outbreak’s earliest days. But it is hard to imagine last year’s aid disruptions helped.

The bigger problem, though, is the place itself.

As we discussed in the last Dispatch, eastern DRC at this moment has almost the worst possible dynamics for this exact kind of virus: dense population centers with constant movement, all alongside active conflict, little trust in authorities, and scant government services.

Conversely, last year’s hemorrhagic fever outbreaks were aided by the fact that they happened in smaller, isolated communities. Places where a virus can even run out of people to infect. Eastern DRC is not that.

And because there is no approved vaccine for the Bundibugyo strain of Ebola, the ongoing response must lean heavily on the basic playbook that requires stable, pliant communities: Finding the sick, isolating them, tracing their contacts, monitoring those contacts… all while earning enough trust that communities actually cooperate. “That is how you get an outbreak under control that has no vaccine,” Hauck said.

But that only works if communities are willing to cooperate. Hauck said the response needs “real active collaboration and commitment of the community,” and right now, “we are not doing very well” on that front. Her team’s early modeling also suggests the outbreak is not moving the same way everywhere. In some places, the response seems to be working better. In others, the virus is spreading faster. That may come down to whether health teams can get in, whether anyone is clearly in charge, and whether traumatized communities trust the people risking their lives while trying to help.

So again, are aid cuts to blame?

Not in the simplest way. The funding picture is murkier, and in some ways less dire, than I expected. But aid cuts may well have weakened the surveillance and partner networks that should have caught this outbreak earlier. And money alone cannot instantly rebuild trust or turn chaos into contact tracing.

That is the heart of this nightmare. Not just that the response needs more money, though it does. It is that this virus is moving through a place, and is in stage of an outbreak, where money can only do so much.

That’s all for now,

-Wm