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[00:00]
Narrator/Advertiser
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[01:12]
Tanya Beckett
Welcome to the Inquiry from the BBC World Service with me, Tanya Beckett. One question, four expert witnesses and experts an answer
[01:23]
Hippolyte Mwindo Mavoco
well, we begin in eastern Dr. Congo, where the World Health Organization says it's working round the clock to trace anyone who might have come into contact with individuals who unknowingly passed on Ebola to them.
[01:37]
Tanya Beckett
On 17 May 2026, the World Health Organization declared the Ebola outbreak in western Africa a public health emergency or of international concern. It was a global call to action in order to prevent this very dangerous disease spreading further across the African continent. But within two days, the Democratic Republic of Congo, or drc, a large country in central Africa, had recorded more than 500 cases. By late May, according to the British Medical journal, more than 200 people in the DRC had died. One death was also reported in neighboring Uganda. The numbers were deeply alarming for an outbreak that had, after all, only just been identified. The virus itself was first recognized in Africa nearly half a century ago. Since then, there have been more than 40 documented outbreaks. Many times they've been contained in rural villages. But an outbreak that started in 2013 followed a very different pattern.
[02:45]
Dr. Juliane Onoko
The declaration of a public health emergency of international concern alerts the world to the need for high vigilance for possible
[02:55]
Tanya Beckett
cases of Ebola virus disease. The virus spread to densely populated urban areas. By the time it had been contained three years later, over 11,000 people had died. The loss of life was primarily in guinea, where the outbreak originated, Liberia and also Sierra Leone. But other countries, even outside Africa, were also affected. This week on the inquiry, we're asking, why does Ebola keep coming back?
[03:33]
Narrator/Advertiser
Part 1 Ebola explained
[03:38]
Tanya Beckett
Ebola is a highly dangerous viral disease which attacks the body's organs and blood vessels. It can lead to severe bleeding and in many cases, death.
[03:49]
Dr. Saramadott
My name is Dr. Saramadott. I'm an infectious disease epidemiologist at the Harbour Belfort Centre.
[03:55]
Tanya Beckett
The progression of the Ebola virus disease can be categorized into two clear parts. the start, it shows a similar pattern to many other infections, such as a cold or flu. But in the second phase, it's characterized by a much more acute illness.
[04:12]
Dr. Saramadott
The dry phase is when you have symptoms that are associated with fever and malaise and weakness and abdominal pain and just, you know, general feeling really, really bad. And then you can progress to what we call the wet phase, which is, you know, when you have vomiting and diarrhea, internal and external bleeding, and then death can result from multi organ failure, shock and, and it could typically happen pretty fast.
[04:37]
Tanya Beckett
The risk of Ebola patients passing on the virus is low in the early or dry stages of the disease, but increases substantially as the symptoms become more severe. And understanding how it is passed on is important.
[04:54]
Dr. Saramadott
It's transmitted to people through close contact, so it's not through casual contact like we think of perhaps during COVID 19 and measles, where it could be airborne. So we know Ebola virus disease is not airborne. And so it's through direct contact with infected body fluids. This can include blood, secretions, organs or other bodily fluids infected.
[05:14]
Tanya Beckett
As our first expert witness says, this is quite different from some other infectious diseases. Those who tend to ill patients appear to be particularly susceptible to infection. In many cases, these are women.
[05:27]
Dr. Saramadott
And so one of the things we often consider when we talk about these types of infectious diseases is how close people are living together, if they're caregivers, if they're in a place where there's weakened healthcare system capacity, weakened public health capacity, A lot of these underlying causes can help ignite Ebola outbreaks in these types of places.
[05:49]
Tanya Beckett
Diagnosing the illness early in the outbreak is of course, vital to stop it spreading. But our first expert witness explains that this can be an awkward task, partly because early symptoms are very similar to other diseases, but also because there are multiple versions of the virus.
[06:07]
Dr. Saramadott
Testing for Ebola virus disease is complicated. And when we talk about diagnostic testing first, there's not just one Ebola virus disease, there are six different species. And so you need to make sure that when you're testing for Ebola, you're testing for the right type of Ebola virus disease that you're thinking may have caused this outbreak.
[06:23]
Tanya Beckett
The fact that the Virus has so many different forms is one of the reasons that treatment and prevention has been slow to emerge. After the massive outbreak in West Africa that started in 2013, a vaccine was developed, but it's only effective in respect of one type of Ebola, and that is the Zaire strain. Importantly, though, it's not effective in respect of the current outbreak.
[06:47]
Dr. Saramadott
The vaccines and the medical countermeasures, meaning the treatment that we have is not universal for all Ebola virus disease species. So the current Ebola virus disease strain that we're dealing with, the Bundebugiovirus, we do not have an effective vaccine for it yet and we don't have treatments for it. So this is not a copy and paste Ebola response playbook that we can use after, you know, one outbreak after another. It has to be species specific. And that was one of the biggest lessons learned.
[07:15]
Tanya Beckett
So what do we know about this latest outbreak and the virus that is causing it? Time for our next expert witness,
[07:24]
Narrator/Advertiser
part two, Inside the outbreak.
[07:29]
Tanya Beckett
The current outbreak that was first identified in the Democratic Republic of Congo in West Africa in May, May 2026 is caused by a form of Ebola first seen in Uganda almost 20 years ago. To understand more, I spoke to an expert based in the capital of the drc.
[07:50]
Hippolyte Mwindo Mavoco
My name is Hippolyte Mwindo Mavoco. I'm a professor at the Department of Tropical Medicine at the University of Kinshasa.
[07:57]
Tanya Beckett
We heard in part one that there's not just one Ebola virus, but instead six different species. The current species or strain circulating is called Bundibugyu. Its effects are comparable to other strains.
[08:12]
Hippolyte Mwindo Mavoco
This strain is less violent, let's say it like that, than the Ebola Zaire.
[08:18]
Tanya Beckett
So when you say that it's less violent, what do you mean by that in terms of the symptoms?
[08:24]
Hippolyte Mwindo Mavoco
The symptoms are similar. But we see, for example with the Ebola Zaire, that up to 90% of patients can die. But in this case, lethality is around 25%. Both viruses belong to the same family. They are transmitted in the same way. The difference is just in the inner characteristics between the different trends. This one is less frequent. We are having it in the DRC for the second time.
[08:55]
Tanya Beckett
So the Bundibugyu strain has in the past been less deadly than other strains. However, the difficulty this time around was spotting it.
[09:05]
Hippolyte Mwindo Mavoco
The outbreak was detected late. It is believed that the virus has been circulating some weeks before the alert, before the confirmation of the outbreak. This is why the dispersion is quite big.
[09:21]
Tanya Beckett
And how do you know that you have contained it.
[09:25]
Hippolyte Mwindo Mavoco
You know, with this system of contact tracing, when we make sure patients all patients are isolated in treatment center, meaning that they are no longer contaminating the people outside. Then all the contacts that are listed, they are followed for 21 days. So when we have 21 days without an alert of a suspect cases occurring in the area, then we wait for additional 21 days. If within 42 days there is no new case, then the outbreak is declared over.
[10:04]
Tanya Beckett
At the end of May 2026, the virus had not been contained. Diagnosis is an important part of achieving that go goal, but precautions, treatments and vaccines also play a vital role. So where are efforts to contain the disease through medical means?
[10:33]
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[11:39]
Tanya Beckett
You're listening to the Inquiry from the BBC World Service. We're about to get into Part three, but before we do, I just wanted to let you know that there's a huge archive of previous episodes available to listen to, including what is the future of the European Union? And should we mine the Moon? Just search for the Inquiry wherever you get your podcasts and while you're there, click subscribe and and turn on push notifications so you never miss a thing.
[12:09]
Narrator/Advertiser
Part 3 One bug, one drug
[12:15]
Tanya Beckett
the massive outbreak that began in December 2013 started in a small village in Guinea, West Africa. In March 2014, the World Health Organization identified The disease as the Zaire strain of Ebola and confirmed cases were already spreading across the border into neighboring Liberia. Amanda Rochek is Associate professor of health emergencies at the University of Oxford in the United Kingdom.
[12:43]
Amanda Rochek
The outbreak in 2013 caused over 28,000 cases, 11,000 deaths, and over 580 healthcare workers died. And so it really galvanised international attention in a way that there hadn't been that focus on Ebola before. So there've been really big changes in the way that we've treated Ebola patients over really the last 10 years.
[13:05]
Tanya Beckett
The struggle to control this large epidemic prompted a fundamental rethink in how Ebola patients could best be cared for and how transmission of the disease could best be avoided.
[13:18]
Amanda Rochek
What we had was really limited supportive care for patients. So patients would sometimes get some pain relief, sometimes they would get some intravenous fluids, but not always. And certainly people were very fearful of patients with Ebola, and so often they got substandard levels of care.
[13:34]
Tanya Beckett
Despite the sheer numbers involved in the devastating outbreak 10 years ago, it became clear that even without drugs, it was possible, with proper handling of patients, to radically improve rates of survival.
[13:48]
Amanda Rochek
If we look Back to the 2013 outbreak, the type of supportive care that was available to patients who were medically evacuated, so workers from high income countries that were repatriated to places like the US or to Europe or the uk, their survival was much, much higher than patients who were treated in West Africa. And so the case fatality rate, the proportion of patients dying that were medically evacuated to high income countries was around 20%. The proportion of patients that we were seeing dying in West Africa was between 50 and 70%.
[14:22]
Tanya Beckett
Only last year, Rwanda in East Africa saw another outbreak of the virus. This was a further separate strain to the one that is causing the outbreak in 2026 and also the one 10 years ago. The Marburg strain, as it's called, is considered one of the deadliest human viruses known to science. Fatality rates can be as high as over 80%. But importantly, in this particular instance, the number of infected people who died were, was actually far lower.
[14:56]
Amanda Rochek
And for the first time in that outbreak, we were able to provide intensive care support to patients who were in one of the countries most affected. And so that involved things like intubating and ventilating a patient. So putting a patient onto life support, and that's a really significant achievement. It means that we are adopting a standard of care that would be the same for me if I was infected and medically evacuated to a high income country or to a local healthcare worker who may not have that opportunity, or a community member who's suffering from the disease. On top of that is now the opportunity to test these treatments.
[15:32]
Tanya Beckett
So far, we've been talking about standard care, which could be used for patients with a wide variety of conditions, for example, oxygen and intravenous fluids. But now we come to the question of drugs. We've said that spotting that the Ebola virus is at the heart of a disease outbreak is slow because of the multiple versions of the virus. This multiplicity makes things complicated when it comes to medicines. But here also, there is some cause for optimism.
[16:04]
Amanda Rochek
One of the really pleasing developments we've seen in terms of countermeasures and in particular in terms of drugs, is the idea of having drugs that work across different viral strains. And so the old adage used to be one bug, one drug, and it meant for every different viral strain of Ebola, we would need to use a different treatment. And really pleasingly, it looks like there are some promising candidate drugs that may have efficacy across the viral strains. And that gives us a really good opportunity to treat patients both with the rarest strains of the virus. But in the event that there was a new viral strain that emerged, one that we hadn't seen before, that we would have potentially much faster countermeasures for that.
[16:42]
Tanya Beckett
But our third expert witness says despite all of the progress made in recent years, it's difficult to project what the outcome will be in this outbreak. Much is dependent on communication to local communities, although, as people understand how to protect others and the measures necessary to recover, survival rates will likely get better.
[17:04]
Amanda Rochek
If a patient realises that they may have symptoms of Ebola, they will seek care at an Ebola treatment unit. At those treatment units, one of the first things that will be done is a test. From that point on, our care consists of really two different things. The fundamental to the way that a patient is cared for is that they get what is called optimized supportive care, and that involves things like IV fluids as well as pain relief, as well as things like nutritional support and also psychosocial support, and so supporting them and their families. As the outbreak goes on, both the quality of care improves, but also patients are much more likely to seek care. And so we see cases of disease that are milder or we see them earlier when we have an opportunity to intervene. And that means that the proportion of patients dying normally falls. And so it's really, unfortunately, too early to know what the likely proportion of patients dying in this output outbreak will be. And hopefully there are things that we can do to drive that number down very quickly.
[18:07]
Tanya Beckett
So the next obvious question then is how can we stop it from coming back?
[18:16]
Narrator/Advertiser
Part 4 Detection and Prevention
[18:22]
Tanya Beckett
if we are to stop Ebola from returning, we need to take a look at where it comes from. The first thing to note is that the reservoir for the virus, so effectively the home where it's thrives is actually bats. In other words, it is a zoonotic disease. Our final Expert witness is Dr. Juliane Onoko. She works as a community engagement officer for the World Health Organization and is talking to us from Nairobi in Kenya.
[18:51]
Dr. Juliane Onoko
The virus is hosted by a bat, but that bat is not sick. So the bat will eat fruit and it can spray the seeds of the fruit on the floor and mammals will eat those fruits. Or even human will go to the forest to hunt. They will either hunt the bats or they can find a dead mammal on the floor and they will collect that dead animal and they will bring it at home. And this is how the disease starts. This is a natural process. Ebola is a zoonotic disease. It comes from animals. So eradicating Ebola means that we have to eradicate the bats, we have to kill all the animals. So eradicating, I don't think that it will happen. However, what we have to do is the prediction.
[19:41]
Tanya Beckett
The difficulty here is that this pattern of existence so close to nature with the eating of bushmeat is commonplace.
[19:49]
Dr. Juliane Onoko
You know, the normal life in these areas where we used to have Ebola outbreaks, they are farmers, they are hunters, or they are going, they visit mines. This is a normal day to day life. It's not something special, you see. So from time to time, we don't know why we will have those bats flying from one place to another and stopping in an area. And people will go to the bush, to the forest, for hunting, for collecting, for farming. And they will take a bat, they will kill a bat and they will kill a mammal and they will feel sick. If that animal is infected by the virus, it's not something special. It's a day in their life of
[20:33]
Tanya Beckett
those people when the virus is first detected and reported. The best case scenario is that the response is rapid and from that the
[20:42]
Dr. Juliane Onoko
medical doctor will make an analysis of that situation. When he will analyze, he will either validate or invalidate it. If it is malaria, he will give them the treatment against the malaria. But if he sees that it's not malaria, he can take the sample and send it for the testing to the laboratory. Once this is done, they can decide, they can agree that this is Ebola or this is not Ebola. But this work is a long term work and is a continuous work.
[21:14]
Tanya Beckett
Stopping the infection at source is complicated. For many rural communities, bushmeat is a vital source of nutrition. It's also gained popularity as a nostalgic food for people who live in cities. Another tradition that can lead to the spread of the disease is burial ceremonies. In some, in some cases, the ceremony involves touching and kissing the dead body. But the corpse itself is still extremely infectious.
[21:41]
Dr. Juliane Onoko
Well, one of the way that we reduce the risk is what we call safe and genified burial. So we have safe and genealed burial protocols, which means that we want the people to continue to do the funeral, but in a safe mode. So we negotiate with the community to do the infection prevention and control of the body, to disinfect the body and to put the body in a body bag. And we don't allow the family to touch the body. And we also inform them not to touch each other, to disinfect their hands and they can do the funeral. This is a negotiation, what we do with the communities at the beginning. So once they accept, we can proceed with the funeral.
[22:25]
Tanya Beckett
This type of messaging is at the very heart of containing outbreaks. But communities are often wary of trusting authorities.
[22:34]
Dr. Juliane Onoko
We have prediction models of where this outbreak can happen and how to prepare the communities and the health system to identify, to detect. Because the problem that we have is that people are not detecting early that this can be Ebola. One thing is detecting. The second thing is report what you have, detect. And we have to inform the community that they are living in this area that are prone to Ebola disease. So anything that is unusual, they have to report it and they have to go to the health care center instead of staying at home and getting worse and even dying. And if there is an unusual death in the community, we have to encourage them to report it.
[23:20]
Tanya Beckett
In May of this year, there were some attacks on treatment clinics, with locals accusing authorities of fabricating the scale of the risk for financial gain and disrespecting long held burial traditions. There's also the problem, and this is the case in some provinces in the DRC of armed conflict.
[23:39]
Dr. Juliane Onoko
One of the critical issues that communities are facing, that people are facing, that even the responder like me, we are facing. So people are fleeing from the conflicts. So when people are moving, they move with the virus. The virus is not left behind, but they move with the virus and they, they go to another place to look for a better place to protect their life from insecurity. And they go and they start the sickness in that other area. This is what is happening now in the eastern part of DRC regarding this current outbreak.
[24:15]
Tanya Beckett
Now we return to our why does Ebola keep coming Back? Efforts to improve drugs to treat the disease have been more concentrated after the devastating outbreak in western Africa over a decade ago. It was announced in mid May that scientists in the UK were working on a vaccine that was effective for the Bundibugyu strain of the virus. A lack of treatments that are effective for all the strains and the cuts in international funding have also played a part in why this disease keeps coming back. But the fact that the virus has its origins in animals that live in the wild makes the prospects for stamping out the disease in the near term almost impossible. You've been listening to the Inquiry from the BBC World Service. Before we finish, I just wanted to let you know there is a huge archive of previous episodes available to listen to, including what is the future of the European Union and and should we mine the moon? Just search for the inquiry wherever you get your podcasts. And while you're there, click subscribe and turn on push notifications so you never miss a thing. This inquiry was written and presented by me, Tanya Beckett. The producer was Matt Tolson, the researcher Amelia Cox the editor was Tom Bigwood and the technical producer was Nicky Edwards. A moment in time captured by what
[25:52]
Narrator/Advertiser
they heard I heard some people making phone calls.
[25:54]
Tanya Beckett
Okay, which Runway would you like at Teterboro?
[25:57]
Hippolyte Mwindo Mavoco
What they saw I put my head down.
[25:59]
Narrator/Advertiser
I saw the movie of my life started going through my head.
[26:01]
Tanya Beckett
What they smelt.
[26:03]
Hippolyte Mwindo Mavoco
I still remember the smell of the
[26:04]
Dr. Juliane Onoko
fresh fish and I completely lost my appetite.
[26:09]
Tanya Beckett
Moments captured which last for a lifetime. Scientists have made the atomic bomb that sort of flash set on fire the birds and they all fell down without their feathers.
[26:19]
Narrator/Advertiser
On the way was clear for Hitler
[26:22]
Hippolyte Mwindo Mavoco
to realize all his demonic plans.
[26:26]
Tanya Beckett
Stories from people with first hand accounts of events that have shaped our world.
[26:33]
Narrator/Advertiser
At the end, Kissinger called me into his office and he said he did a good job. I left the office with tears in my eyes.
[26:41]
Tanya Beckett
She called me and told me I'm doing Studio 54. She had already become a star in Paris. She came back a superstar. Listen now. Search for witness history wherever you get your BBC podcasts.
[26:59]
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Summary6 min read

Podcast Summary: The Inquiry – "Why does Ebola keep coming back?"

BBC World Service, June 9, 2026
Host: Tanya Beckett

Overview of the Episode

This episode of The Inquiry tackles the persistent re-emergence of Ebola outbreaks in Africa, exploring why the virus continues to return despite improvements in medical science, knowledge, and public health interventions. Guided by host Tanya Beckett, the episode breaks down the biology of Ebola, lessons from past epidemics, the challenges of diagnosis, treatment advances, and the societal and environmental factors making eradication so difficult. Four expert witnesses contribute perspectives from epidemiology, medicine, emergency response, and community engagement.

Key Discussion Points and Insights

1. Understanding Ebola: The Biology and its Challenge

[03:32–07:14]

Transmission and Disease Progression
- Ebola is a highly dangerous viral disease, leading to severe organ and blood vessel damage.
- Initial “dry phase” symptoms mimic common infections (fever, malaise), later escalating to “wet phase” symptoms like profuse vomiting, diarrhea, bleeding, and potentially rapid death.
  
  "The dry phase is when you have symptoms ... general feeling really, really bad. And then you can progress to what we call the wet phase ... vomiting and diarrhea, internal and external bleeding, and then death can result from multi organ failure, shock and, and it could typically happen pretty fast."
  — Dr. Saramadott, epidemiologist [04:12]
Transmission Mechanics
- Transmission occurs via direct contact with infected bodily fluids.
- Not airborne—a vital distinction from diseases like COVID-19 or measles.
  
  "It's transmitted ... through direct contact with infected body fluids."
  — Dr. Saramadott [04:53]
Challenges in Diagnosis and Treatment
- Diagnosis is complicated, due to multiple species (“not just one Ebola virus disease, there are six different species”).
- The vaccine developed after the 2013–16 outbreak is only effective against the Zaire strain, not for the currently circulating Bundibugyu strain.
  
  "We do not have an effective vaccine for it yet and we don't have treatments for it."
  — Dr. Saramadott [06:47]

2. The 2026 DRC Outbreak: Inside the Crisis

[07:23–10:03]

Current Strain and Its Lethality
- The 2026 DRC outbreak is driven by the Bundibugyu strain—less deadly (approx. 25% fatality) than Ebola Zaire (up to 90%).
- Outbreak detected late, causing wider spread.
  
  "The outbreak was detected late. It is believed that the virus has been circulating some weeks before the alert ... This is why the dispersion is quite big."
  — Prof. Hippolyte Mwindo Mavoco, University of Kinshasa [09:04]
Containment Strategy
- Emphasis on patient isolation and contact tracing.
- An outbreak is declared over after 42 consecutive days with no new cases.
  
  "When we have 21 days without an alert ... then we wait for additional 21 days. If within 42 days there is no new case, then the outbreak is declared over."
  — Prof. Mavoco [09:24]

3. Advances and Limitations in Treatment

[12:09–17:04]

Evolution of Patient Care
- 2013 West Africa outbreak prompted international focus and improved supportive care.
- Survival rates much higher for patients in high-income settings (20%) versus West Africa during the 2013–16 epidemic (50–70%).
  
  "The case fatality rate ... for patients evacuated to high income countries was around 20%. ... in West Africa ... between 50 and 70%."
  — Amanda Rochek, University of Oxford [13:47]
Promising Developments: ‘One Bug, One Drug’ Shifts
- Historically, only strain-specific treatments were available.
- New candidate drugs may now offer cross-strain efficacy, improving agility against new or rare epidemics.
  
  "One of the really pleasing developments ... is the idea of having drugs that work across different viral strains."
  — Amanda Rochek [16:03]
Role of Optimized Supportive Care
- Early presentation and optimized supportive care (IV fluids, pain relief, nutritional and psychosocial support) increase survival.
- Survival rates improve as communities become educated and seek care sooner.
  
  "As the outbreak goes on, both the quality of care improves, but also patients are much more likely to seek care. ... the proportion of patients dying normally falls."
  — Amanda Rochek [17:04]

4. Why Ebola Keeps Returning: Ecology, Culture, and Instability

[18:09–23:39]

The Natural Reservoir
- Ebola is zoonotic; its reservoir is fruit bats (which do not themselves get sick).
- Transmission to humans is usually through hunting, handling or consumption of infected bushmeat, or contact with dead animals.
  
  "The virus is hosted by a bat, but that bat is not sick ... people will go to the bush ... they will take a bat, they will kill a bat and they will kill a mammal and they will feel sick."
  — Dr. Juliane Onoko, WHO [18:50]
Barriers to Eradication
- Given Ebola’s wildlife origin, true eradication would require eliminating the host species—impractical and ecologically damaging.
- Prevention depends on prediction, community awareness, rapid detection, and behavioral change.
  
  "So eradicating, I don't think that it will happen. However, what we have to do is the prediction."
  — Dr. Onoko [19:41]
Social Behaviors and Outbreak Amplification
- Rural poverty, dependence on bushmeat, and traditional burial practices (e.g., touching the dead) amplify risk.
- "Safe and dignified burial" protocols are negotiated with communities to respect tradition and minimize contagion.
  
  "We want the people to continue to do the funeral, but in a safe mode. ... we don't allow the family to touch the body."
  — Dr. Onoko [21:41]
Mistrust and Conflict Exacerbate Spread
- Attacks on clinics, distrust of authorities, and misinformation hamper efforts.
- Armed conflict leads to population displacement, moving the virus to new areas.
  
  "People are fleeing from the conflicts. So when people are moving, they move with the virus."
  — Dr. Onoko [23:39]

Notable Quotes & Memorable Moments

On Ebola’s complexity:

"This is not a copy and paste Ebola response playbook that we can use after, you know, one outbreak after another. It has to be species specific."
— Dr. Saramadott [06:47]
On the natural cycle of outbreaks:

"It's not something special. It's a day in their life of those people."
— Dr. Onoko, on rural exposure risks [19:49]
On community engagement in burials:

"This is a negotiation, what we do with the communities at the beginning. So once they accept, we can proceed with the funeral."
— Dr. Onoko [21:41]

Important Segment Timestamps

[01:12–03:32] — Introduction and framing of Ebola’s prevalence and history.
[03:32–07:14] — Biology and medical challenge of Ebola explained by Dr. Saramadott.
[07:23–10:03] — Inside the 2026 DRC outbreak; Prof. Mavoco on local response methods.
[12:09–17:04] — Lessons from prior outbreaks; advances in supportive care and cross-strain therapies with Amanda Rochek.
[18:21–24:15] — Natural origins, behavioral, and socio-cultural challenges with Dr. Juliane Onoko.
[23:39–24:15] — Impact of mistrust and conflict on outbreak dynamics.

Conclusion

Why does Ebola keep coming back? The episode’s answer is multi-faceted:

The virus’s animal reservoir (bats) makes eradication near impossible.
Diagnostic, logistic, and medical challenges persist, especially with multiple viral strains.
Poverty, traditional behaviors (such as bushmeat and burials), and armed conflict create ongoing risk.
Community trust and engagement remain critical obstacles and opportunities.
New treatments, cross-strain drugs, and expanding vaccine research offer hope, but the combination of ecological realities and societal complexity means outbreaks will likely continue.

Bottom line:
Ebola persists not for lack of medical progress, but due to a complex web of biology, ecology, culture, and conflict—requiring vigilance, adaptation, and trust-building for every new outbreak.

(For more episodes of The Inquiry, search your podcast provider or visit the BBC World Service.)

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[00:00]
Narrator/Advertiser
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[01:12]
Tanya Beckett
Welcome to the Inquiry from the BBC World Service with me, Tanya Beckett. One question, four expert witnesses and experts an answer
[01:23]
Hippolyte Mwindo Mavoco
well, we begin in eastern Dr. Congo, where the World Health Organization says it's working round the clock to trace anyone who might have come into contact with individuals who unknowingly passed on Ebola to them.
[01:37]
Tanya Beckett
On 17 May 2026, the World Health Organization declared the Ebola outbreak in western Africa a public health emergency or of international concern. It was a global call to action in order to prevent this very dangerous disease spreading further across the African continent. But within two days, the Democratic Republic of Congo, or drc, a large country in central Africa, had recorded more than 500 cases. By late May, according to the British Medical journal, more than 200 people in the DRC had died. One death was also reported in neighboring Uganda. The numbers were deeply alarming for an outbreak that had, after all, only just been identified. The virus itself was first recognized in Africa nearly half a century ago. Since then, there have been more than 40 documented outbreaks. Many times they've been contained in rural villages. But an outbreak that started in 2013 followed a very different pattern.
[02:45]
Dr. Juliane Onoko
The declaration of a public health emergency of international concern alerts the world to the need for high vigilance for possible
[02:55]
Tanya Beckett
cases of Ebola virus disease. The virus spread to densely populated urban areas. By the time it had been contained three years later, over 11,000 people had died. The loss of life was primarily in guinea, where the outbreak originated, Liberia and also Sierra Leone. But other countries, even outside Africa, were also affected. This week on the inquiry, we're asking, why does Ebola keep coming back?
[03:33]
Narrator/Advertiser
Part 1 Ebola explained
[03:38]
Tanya Beckett
Ebola is a highly dangerous viral disease which attacks the body's organs and blood vessels. It can lead to severe bleeding and in many cases, death.
[03:49]
Dr. Saramadott
My name is Dr. Saramadott. I'm an infectious disease epidemiologist at the Harbour Belfort Centre.
[03:55]
Tanya Beckett
The progression of the Ebola virus disease can be categorized into two clear parts. the start, it shows a similar pattern to many other infections, such as a cold or flu. But in the second phase, it's characterized by a much more acute illness.
[04:12]
Dr. Saramadott
The dry phase is when you have symptoms that are associated with fever and malaise and weakness and abdominal pain and just, you know, general feeling really, really bad. And then you can progress to what we call the wet phase, which is, you know, when you have vomiting and diarrhea, internal and external bleeding, and then death can result from multi organ failure, shock and, and it could typically happen pretty fast.
[04:37]
Tanya Beckett
The risk of Ebola patients passing on the virus is low in the early or dry stages of the disease, but increases substantially as the symptoms become more severe. And understanding how it is passed on is important.
[04:54]
Dr. Saramadott
It's transmitted to people through close contact, so it's not through casual contact like we think of perhaps during COVID 19 and measles, where it could be airborne. So we know Ebola virus disease is not airborne. And so it's through direct contact with infected body fluids. This can include blood, secretions, organs or other bodily fluids infected.
[05:14]
Tanya Beckett
As our first expert witness says, this is quite different from some other infectious diseases. Those who tend to ill patients appear to be particularly susceptible to infection. In many cases, these are women.
[05:27]
Dr. Saramadott
And so one of the things we often consider when we talk about these types of infectious diseases is how close people are living together, if they're caregivers, if they're in a place where there's weakened healthcare system capacity, weakened public health capacity, A lot of these underlying causes can help ignite Ebola outbreaks in these types of places.
[05:49]
Tanya Beckett
Diagnosing the illness early in the outbreak is of course, vital to stop it spreading. But our first expert witness explains that this can be an awkward task, partly because early symptoms are very similar to other diseases, but also because there are multiple versions of the virus.
[06:07]
Dr. Saramadott
Testing for Ebola virus disease is complicated. And when we talk about diagnostic testing first, there's not just one Ebola virus disease, there are six different species. And so you need to make sure that when you're testing for Ebola, you're testing for the right type of Ebola virus disease that you're thinking may have caused this outbreak.
[06:23]
Tanya Beckett
The fact that the Virus has so many different forms is one of the reasons that treatment and prevention has been slow to emerge. After the massive outbreak in West Africa that started in 2013, a vaccine was developed, but it's only effective in respect of one type of Ebola, and that is the Zaire strain. Importantly, though, it's not effective in respect of the current outbreak.
[06:47]
Dr. Saramadott
The vaccines and the medical countermeasures, meaning the treatment that we have is not universal for all Ebola virus disease species. So the current Ebola virus disease strain that we're dealing with, the Bundebugiovirus, we do not have an effective vaccine for it yet and we don't have treatments for it. So this is not a copy and paste Ebola response playbook that we can use after, you know, one outbreak after another. It has to be species specific. And that was one of the biggest lessons learned.
[07:15]
Tanya Beckett
So what do we know about this latest outbreak and the virus that is causing it? Time for our next expert witness,
[07:24]
Narrator/Advertiser
part two, Inside the outbreak.
[07:29]
Tanya Beckett
The current outbreak that was first identified in the Democratic Republic of Congo in West Africa in May, May 2026 is caused by a form of Ebola first seen in Uganda almost 20 years ago. To understand more, I spoke to an expert based in the capital of the drc.
[07:50]
Hippolyte Mwindo Mavoco
My name is Hippolyte Mwindo Mavoco. I'm a professor at the Department of Tropical Medicine at the University of Kinshasa.
[07:57]
Tanya Beckett
We heard in part one that there's not just one Ebola virus, but instead six different species. The current species or strain circulating is called Bundibugyu. Its effects are comparable to other strains.
[08:12]
Hippolyte Mwindo Mavoco
This strain is less violent, let's say it like that, than the Ebola Zaire.
[08:18]
Tanya Beckett
So when you say that it's less violent, what do you mean by that in terms of the symptoms?
[08:24]
Hippolyte Mwindo Mavoco
The symptoms are similar. But we see, for example with the Ebola Zaire, that up to 90% of patients can die. But in this case, lethality is around 25%. Both viruses belong to the same family. They are transmitted in the same way. The difference is just in the inner characteristics between the different trends. This one is less frequent. We are having it in the DRC for the second time.
[08:55]
Tanya Beckett
So the Bundibugyu strain has in the past been less deadly than other strains. However, the difficulty this time around was spotting it.
[09:05]
Hippolyte Mwindo Mavoco
The outbreak was detected late. It is believed that the virus has been circulating some weeks before the alert, before the confirmation of the outbreak. This is why the dispersion is quite big.
[09:21]
Tanya Beckett
And how do you know that you have contained it.
[09:25]
Hippolyte Mwindo Mavoco
You know, with this system of contact tracing, when we make sure patients all patients are isolated in treatment center, meaning that they are no longer contaminating the people outside. Then all the contacts that are listed, they are followed for 21 days. So when we have 21 days without an alert of a suspect cases occurring in the area, then we wait for additional 21 days. If within 42 days there is no new case, then the outbreak is declared over.
[10:04]
Tanya Beckett
At the end of May 2026, the virus had not been contained. Diagnosis is an important part of achieving that go goal, but precautions, treatments and vaccines also play a vital role. So where are efforts to contain the disease through medical means?
[10:33]
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[11:06]
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[11:39]
Tanya Beckett
You're listening to the Inquiry from the BBC World Service. We're about to get into Part three, but before we do, I just wanted to let you know that there's a huge archive of previous episodes available to listen to, including what is the future of the European Union? And should we mine the Moon? Just search for the Inquiry wherever you get your podcasts and while you're there, click subscribe and and turn on push notifications so you never miss a thing.
[12:09]
Narrator/Advertiser
Part 3 One bug, one drug
[12:15]
Tanya Beckett
the massive outbreak that began in December 2013 started in a small village in Guinea, West Africa. In March 2014, the World Health Organization identified The disease as the Zaire strain of Ebola and confirmed cases were already spreading across the border into neighboring Liberia. Amanda Rochek is Associate professor of health emergencies at the University of Oxford in the United Kingdom.
[12:43]
Amanda Rochek
The outbreak in 2013 caused over 28,000 cases, 11,000 deaths, and over 580 healthcare workers died. And so it really galvanised international attention in a way that there hadn't been that focus on Ebola before. So there've been really big changes in the way that we've treated Ebola patients over really the last 10 years.
[13:05]
Tanya Beckett
The struggle to control this large epidemic prompted a fundamental rethink in how Ebola patients could best be cared for and how transmission of the disease could best be avoided.
[13:18]
Amanda Rochek
What we had was really limited supportive care for patients. So patients would sometimes get some pain relief, sometimes they would get some intravenous fluids, but not always. And certainly people were very fearful of patients with Ebola, and so often they got substandard levels of care.
[13:34]
Tanya Beckett
Despite the sheer numbers involved in the devastating outbreak 10 years ago, it became clear that even without drugs, it was possible, with proper handling of patients, to radically improve rates of survival.
[13:48]
Amanda Rochek
If we look Back to the 2013 outbreak, the type of supportive care that was available to patients who were medically evacuated, so workers from high income countries that were repatriated to places like the US or to Europe or the uk, their survival was much, much higher than patients who were treated in West Africa. And so the case fatality rate, the proportion of patients dying that were medically evacuated to high income countries was around 20%. The proportion of patients that we were seeing dying in West Africa was between 50 and 70%.
[14:22]
Tanya Beckett
Only last year, Rwanda in East Africa saw another outbreak of the virus. This was a further separate strain to the one that is causing the outbreak in 2026 and also the one 10 years ago. The Marburg strain, as it's called, is considered one of the deadliest human viruses known to science. Fatality rates can be as high as over 80%. But importantly, in this particular instance, the number of infected people who died were, was actually far lower.
[14:56]
Amanda Rochek
And for the first time in that outbreak, we were able to provide intensive care support to patients who were in one of the countries most affected. And so that involved things like intubating and ventilating a patient. So putting a patient onto life support, and that's a really significant achievement. It means that we are adopting a standard of care that would be the same for me if I was infected and medically evacuated to a high income country or to a local healthcare worker who may not have that opportunity, or a community member who's suffering from the disease. On top of that is now the opportunity to test these treatments.
[15:32]
Tanya Beckett
So far, we've been talking about standard care, which could be used for patients with a wide variety of conditions, for example, oxygen and intravenous fluids. But now we come to the question of drugs. We've said that spotting that the Ebola virus is at the heart of a disease outbreak is slow because of the multiple versions of the virus. This multiplicity makes things complicated when it comes to medicines. But here also, there is some cause for optimism.
[16:04]
Amanda Rochek
One of the really pleasing developments we've seen in terms of countermeasures and in particular in terms of drugs, is the idea of having drugs that work across different viral strains. And so the old adage used to be one bug, one drug, and it meant for every different viral strain of Ebola, we would need to use a different treatment. And really pleasingly, it looks like there are some promising candidate drugs that may have efficacy across the viral strains. And that gives us a really good opportunity to treat patients both with the rarest strains of the virus. But in the event that there was a new viral strain that emerged, one that we hadn't seen before, that we would have potentially much faster countermeasures for that.
[16:42]
Tanya Beckett
But our third expert witness says despite all of the progress made in recent years, it's difficult to project what the outcome will be in this outbreak. Much is dependent on communication to local communities, although, as people understand how to protect others and the measures necessary to recover, survival rates will likely get better.
[17:04]
Amanda Rochek
If a patient realises that they may have symptoms of Ebola, they will seek care at an Ebola treatment unit. At those treatment units, one of the first things that will be done is a test. From that point on, our care consists of really two different things. The fundamental to the way that a patient is cared for is that they get what is called optimized supportive care, and that involves things like IV fluids as well as pain relief, as well as things like nutritional support and also psychosocial support, and so supporting them and their families. As the outbreak goes on, both the quality of care improves, but also patients are much more likely to seek care. And so we see cases of disease that are milder or we see them earlier when we have an opportunity to intervene. And that means that the proportion of patients dying normally falls. And so it's really, unfortunately, too early to know what the likely proportion of patients dying in this output outbreak will be. And hopefully there are things that we can do to drive that number down very quickly.
[18:07]
Tanya Beckett
So the next obvious question then is how can we stop it from coming back?
[18:16]
Narrator/Advertiser
Part 4 Detection and Prevention
[18:22]
Tanya Beckett
if we are to stop Ebola from returning, we need to take a look at where it comes from. The first thing to note is that the reservoir for the virus, so effectively the home where it's thrives is actually bats. In other words, it is a zoonotic disease. Our final Expert witness is Dr. Juliane Onoko. She works as a community engagement officer for the World Health Organization and is talking to us from Nairobi in Kenya.
[18:51]
Dr. Juliane Onoko
The virus is hosted by a bat, but that bat is not sick. So the bat will eat fruit and it can spray the seeds of the fruit on the floor and mammals will eat those fruits. Or even human will go to the forest to hunt. They will either hunt the bats or they can find a dead mammal on the floor and they will collect that dead animal and they will bring it at home. And this is how the disease starts. This is a natural process. Ebola is a zoonotic disease. It comes from animals. So eradicating Ebola means that we have to eradicate the bats, we have to kill all the animals. So eradicating, I don't think that it will happen. However, what we have to do is the prediction.
[19:41]
Tanya Beckett
The difficulty here is that this pattern of existence so close to nature with the eating of bushmeat is commonplace.
[19:49]
Dr. Juliane Onoko
You know, the normal life in these areas where we used to have Ebola outbreaks, they are farmers, they are hunters, or they are going, they visit mines. This is a normal day to day life. It's not something special, you see. So from time to time, we don't know why we will have those bats flying from one place to another and stopping in an area. And people will go to the bush, to the forest, for hunting, for collecting, for farming. And they will take a bat, they will kill a bat and they will kill a mammal and they will feel sick. If that animal is infected by the virus, it's not something special. It's a day in their life of
[20:33]
Tanya Beckett
those people when the virus is first detected and reported. The best case scenario is that the response is rapid and from that the
[20:42]
Dr. Juliane Onoko
medical doctor will make an analysis of that situation. When he will analyze, he will either validate or invalidate it. If it is malaria, he will give them the treatment against the malaria. But if he sees that it's not malaria, he can take the sample and send it for the testing to the laboratory. Once this is done, they can decide, they can agree that this is Ebola or this is not Ebola. But this work is a long term work and is a continuous work.
[21:14]
Tanya Beckett
Stopping the infection at source is complicated. For many rural communities, bushmeat is a vital source of nutrition. It's also gained popularity as a nostalgic food for people who live in cities. Another tradition that can lead to the spread of the disease is burial ceremonies. In some, in some cases, the ceremony involves touching and kissing the dead body. But the corpse itself is still extremely infectious.
[21:41]
Dr. Juliane Onoko
Well, one of the way that we reduce the risk is what we call safe and genified burial. So we have safe and genealed burial protocols, which means that we want the people to continue to do the funeral, but in a safe mode. So we negotiate with the community to do the infection prevention and control of the body, to disinfect the body and to put the body in a body bag. And we don't allow the family to touch the body. And we also inform them not to touch each other, to disinfect their hands and they can do the funeral. This is a negotiation, what we do with the communities at the beginning. So once they accept, we can proceed with the funeral.
[22:25]
Tanya Beckett
This type of messaging is at the very heart of containing outbreaks. But communities are often wary of trusting authorities.
[22:34]
Dr. Juliane Onoko
We have prediction models of where this outbreak can happen and how to prepare the communities and the health system to identify, to detect. Because the problem that we have is that people are not detecting early that this can be Ebola. One thing is detecting. The second thing is report what you have, detect. And we have to inform the community that they are living in this area that are prone to Ebola disease. So anything that is unusual, they have to report it and they have to go to the health care center instead of staying at home and getting worse and even dying. And if there is an unusual death in the community, we have to encourage them to report it.
[23:20]
Tanya Beckett
In May of this year, there were some attacks on treatment clinics, with locals accusing authorities of fabricating the scale of the risk for financial gain and disrespecting long held burial traditions. There's also the problem, and this is the case in some provinces in the DRC of armed conflict.
[23:39]
Dr. Juliane Onoko
One of the critical issues that communities are facing, that people are facing, that even the responder like me, we are facing. So people are fleeing from the conflicts. So when people are moving, they move with the virus. The virus is not left behind, but they move with the virus and they, they go to another place to look for a better place to protect their life from insecurity. And they go and they start the sickness in that other area. This is what is happening now in the eastern part of DRC regarding this current outbreak.
[24:15]
Tanya Beckett
Now we return to our why does Ebola keep coming Back? Efforts to improve drugs to treat the disease have been more concentrated after the devastating outbreak in western Africa over a decade ago. It was announced in mid May that scientists in the UK were working on a vaccine that was effective for the Bundibugyu strain of the virus. A lack of treatments that are effective for all the strains and the cuts in international funding have also played a part in why this disease keeps coming back. But the fact that the virus has its origins in animals that live in the wild makes the prospects for stamping out the disease in the near term almost impossible. You've been listening to the Inquiry from the BBC World Service. Before we finish, I just wanted to let you know there is a huge archive of previous episodes available to listen to, including what is the future of the European Union and and should we mine the moon? Just search for the inquiry wherever you get your podcasts. And while you're there, click subscribe and turn on push notifications so you never miss a thing. This inquiry was written and presented by me, Tanya Beckett. The producer was Matt Tolson, the researcher Amelia Cox the editor was Tom Bigwood and the technical producer was Nicky Edwards. A moment in time captured by what
[25:52]
Narrator/Advertiser
they heard I heard some people making phone calls.
[25:54]
Tanya Beckett
Okay, which Runway would you like at Teterboro?
[25:57]
Hippolyte Mwindo Mavoco
What they saw I put my head down.
[25:59]
Narrator/Advertiser
I saw the movie of my life started going through my head.
[26:01]
Tanya Beckett
What they smelt.
[26:03]
Hippolyte Mwindo Mavoco
I still remember the smell of the
[26:04]
Dr. Juliane Onoko
fresh fish and I completely lost my appetite.
[26:09]
Tanya Beckett
Moments captured which last for a lifetime. Scientists have made the atomic bomb that sort of flash set on fire the birds and they all fell down without their feathers.
[26:19]
Narrator/Advertiser
On the way was clear for Hitler
[26:22]
Hippolyte Mwindo Mavoco
to realize all his demonic plans.
[26:26]
Tanya Beckett
Stories from people with first hand accounts of events that have shaped our world.
[26:33]
Narrator/Advertiser
At the end, Kissinger called me into his office and he said he did a good job. I left the office with tears in my eyes.
[26:41]
Tanya Beckett
She called me and told me I'm doing Studio 54. She had already become a star in Paris. She came back a superstar. Listen now. Search for witness history wherever you get your BBC podcasts.
[26:59]
Narrator/Advertiser
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