The return of Ebola

Summary

Podcast Summary: The Story – "The Return of Ebola"
Date: May 20, 2026
Host: Manveen Rana (The Times)
Expert Guest: Prof. Paul Hunter, Professor of Medicine, University of East Anglia

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Episode Overview

This episode tackles the alarming resurgence of Ebola in Central Africa, focusing on the rapidly escalating outbreak in the Democratic Republic of Congo (DRC) and Uganda. Host Manveen Rana interviews Professor Paul Hunter, an expert in medical microbiology and virology, delving into the outbreak's origins, the challenges in containment, why the crisis caught the world off guard, and how global health cuts are impacting our response to epidemics like this.

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Key Discussion Points and Insights

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1. The Outbreak Unfolds

• Escalating Emergency

  • By the time of recording, the death toll had risen to 130+ with over 500 suspected cases in the DRC and Uganda ([02:32]).
  • Dr. Tedros Adhanom Ghebreyesus (WHO) declared a "public health emergency of international concern" ([02:18]).
  • The virus was spreading fast but had not yet reached full global pandemic scale.

• Early Cases and Health Worker Risks

  • The first confirmed fatality was a healthcare worker—a common pattern in Ebola outbreaks due to high-risk exposure ([05:46]; [06:26]).
  • Funerary traditions involving washing the dead greatly accelerate local and regional spread ([06:54]; [07:03]).
    • "If you... don't have a small contained outbreak of Ebola, you have Ebola cases potentially cropping up all over the place." – Prof. Hunter [07:19]

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2. Factors Fueling the Crisis

• Transmission Dynamics

  • Transmission requires close contact with body fluids, whether of the living or the recently deceased ([07:38]).
  • Ebola virus can be sexually transmitted for months after recovery, complicating eradication ([08:10]).
  • Spillover typically occurs from bats, often with an intermediate mammal host ([05:46]).

• Regional Challenges

  • The affected area is plagued by ongoing conflict, targeted attacks on healthcare workers, and mass displacement across borders, especially into Uganda ([09:05]–[10:03]).
  • Surveillance and response are critically hindered:
    • "In a war setting, to get good surveillance to know what's going on... is actually very difficult." – Prof. Hunter [09:23]

• Delayed Detection

  • The outbreak likely started at least a month before it was detected, with poor surveillance blamed for the delayed response ([10:46]; [11:22]).

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3. Ebola: Medical Details & Vaccine Issues

• Strain Information

  • This outbreak is caused by the Bundibuya species—the sixth known Ebola type ([13:32]).
  • It has a lower fatality rate than the more common Zaire Ebola (c.33% vs. c.75%), but there is no existing effective vaccine for this strain ([13:38]; [14:05]).

• Clinical Course

  • Symptoms: Fever, vomiting, diarrhoea, cognitive decline, bleeding from orifices (hemorrhagic syndrome)([14:32]).
  • Treatment is supportive—patients are nursed until (hopefully) their immune systems clear the virus ([16:10]).

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4. Containment Challenges

• Containment Strategies

  • Early and rapid identification of cases is paramount ([16:10]).
  • Misinformation and social resistance undermine treatment and isolation efforts, as seen in previous epidemics ([16:45]).
    • "People would often think, 'I'm getting sick... If I go to the Ebola treatment center, I'll die.'" – Prof. Hunter [16:34]

• Infrastructure Needs

  • Massive resource needs for PPE, staffing, and infrastructure ([12:11]; [23:44]).
  • Regional shortages in healthcare capacity and laboratory support necessitate international intervention ([13:11]; [23:44]).

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5. The International Response and its Weaknesses

• Aid Cuts and Vulnerability

  • Global aid cuts (notably from US and UK) are weakening the world’s defense against outbreaks, leaving poorer nations especially vulnerable ([25:53]).
    • "Ensuring that infectious diseases are identified and dealt with before they become international problems... is actually protecting yourself." – Prof. Hunter [26:37]

• Preparedness Doubts

  • Despite high theoretical preparedness in reports, the COVID-19 pandemic revealed significant shortfalls in real-world responses ([27:25]).

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6. Broader Context and Future Risks

• Origins and Outlook

  • Ebola was first "discovered" in 1976, but almost certainly had been endemic for centuries ([20:46]).
  • Outbreaks are increasing, linked to population expansion into wilderness, road building, and climate change ([21:44]).
    • "People move along [roads], build settlements... come into contact with animals... and [viruses] spread." – Prof. Hunter [21:55]

• Resource Gaps

  • Experience and local knowledge exist in the DRC, but years of under-resourcing (exacerbated by conflict and poverty) mean this is not enough ([23:00]).
  • International logistics, from flying in supplies to deploying specialists, are critical in outbreak response ([23:44]; [24:19]).

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Notable Quotes & Memorable Moments

• "This is not a mystical disease. Make yourself known so that you can be taken care of..." – DRC Health Minister ([03:04])
• "What concerns me most is that we learned way too much, way too quickly for this to be anything but really bad." – Prof. Hunter ([03:20])
• "There is more than just experience about better prepared. There's resources... resources might not well be." – Prof. Hunter ([23:00])
• "We try [to predict outbreaks], but as we saw with COVID, we don't always get it right. You've got to hope it won't get much worse, but prepare for if it does." – Prof. Hunter ([28:09])

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Timestamps for Key Sections

• Outbreak background and urgent response: [01:35]–[04:10]
• Expert interview introduction: [04:10]
• Ebola transmission, funerals, initial spread: [05:36]–[07:29]
• Surveillance challenges, regional conflict: [09:05]–[11:22]
• Strain specifics & lack of vaccine: [13:20]–[15:45]
• Containment, treatment, and misinformation: [16:10]–[17:17]
• History and drivers of Ebola outbreaks: [20:27]–[22:46]
• International response, need for resources: [23:44]–[25:53]
• Global preparedness and the cost of cuts: [25:53]–[29:21]

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Overall Tone and Takeaway

Urgency, realism, and caution dominate the tone of this episode. The discussion emphasizes that while Africa has developed expertise in dealing with Ebola due to painful experience, lack of resources, global aid cuts, and regional conflict make the current situation especially precarious. Professor Hunter speaks candidly about vulnerabilities not just of affected nations, but of the global system—a system revealed to be more fragile than many realized. The episode closes with a warning: hope for the best, but prepare for escalation.

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For More:
Questions can be sent to [e-mail] for a future Q&A ([17:17]).

Transcript

[A]

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[C]

From the Times and the Sunday Times, this is the story. I'm Manveen Rana. While the world was grappling with the strange news of an outbreak of hantavirus aboard a Dutch cruise ship on land, another health crisis was brewing. Health officials are racing to contain a

[A]

rapidly expanding outbreak of a rare strain

[C]

of Ebola in Central when the news broke over the weekend that almost 90 people had already died of Ebola, with around another 300 suspected cases, the World Health Organization, led by Dr. Tedros Adhanom Ghebreyesus, acted quickly.

[B]

Early on Sunday, I declared a public health emergency of international concern over an epidemic of Ebola disease in the Democratic Republic of the Congo and Uganda by Tuesday afternoon.

[C]

At the time of recording this episode, the death toll has already risen to more than 130, with more than 500 suspected cases.

[D]

I'm deeply concerned about the scale and

[B]

speed of the epidemic.

[C]

Health officials are scrambling to respond. In the Democratic Republic of Congo, where most of the cases have been identified, the Health Minister has issued a plea for those with symptoms to come forward immediately.

[B]

This is not a mystical disease. Make yourself known. Make yourself known so that you can be taken care of and so that we can prevent the disease from spreading.

[C]

But health experts around the world are worried that this is just the beginning.

[D]

What concerns me most is that we learned way too much, way too quickly for this to be anything but really bad.

[B]

I am concerned about the next few

[D]

weeks or the next few months. We still don't have a full handle

[B]

on what exactly we're grappling with yet.

[C]

So why didn't we know about the crisis sooner? How much worse could it get before it's contained? And after global health cuts from the United States, the UK and other Western governments, are we more vulnerable to outbreaks of infectious diseases? The story today, the return of Ebola, a new global health emergency.

[D]

I'm Paul Hunter, I'm professor in medicine at the Norwich Medical School in the University of East Anglia. I'm a medical doctor by training and I specialised in medical microbiology, clinical virology.

[C]

And this isn't the first time you've had to look at Ebola in particular. Just tell us a bit about some of your experiences with the disease.

[D]

Yeah. Back in 2014, when we had the West African epidemic, which was the biggest epidemic of Ebola since we described it, I was involved in United nations expert committee, particularly looking at issues around waste disposal from Ebola treatment centers. Because in Ebola treatment centers you generate a lot of waste that is potentially infectious and how you dispose of that was not immediately clear. I think at the beginning of the outbreak there was certainly a lot of concern amongst professionals and issues around, well, what about toilets from hospitals where they might have a nipolar patient, you know, does that pose risks to sewage workers? And there was quite a bit of debate around that and a lot of fear, particularly amongst people working in, in the wastewater industry. So it was quite an intensive couple of years for myself and my research group.

[C]

And take us back to the start of this outbreak or what we know of it, you know, what were the origins of this particular spread?

[D]

Well, at the moment it's very uncertain. All Ebola outbreaks start with an animal to human transmission, usually contact with bats, but sometimes with an intermediate mammal host. I believe that the first person who died was a healthcare worker and that it would not be unusual, because being a healthcare worker is one of the biggest risk factors for Ebola, because you come very close to the patient, you wash the patient, you clear up their vomit and blood. And it's these body fluids that are the main risk of transmission. We know that particularly in the African context, which most outbreaks are traditional funerals are often accelerator events because in a number of cultures there's a lot more physical contact with the recently deceased than we would expect to see in the West. As the deceased is prepared for burial, are often times when the virus can spread and actually can spread to multiple people at the same time as they pay their respects to their relative or friend.

[C]

So is this sort of washing the body? We hear that that's a very traditional part of the ceremony in this part of Africa.

[D]

Yes. And that has often been an event that has transferred a relatively small outbreak in a localized area to quite a widespread outbreak, because people come from all over the place to pay their respects. You know, people might come miles and then go back home. And if you suddenly you don't have a small contained outbreak of Ebola, you have Ebola cases potentially cropping up all over the place.

[C]

You know, and just clarify for us, how close do you have to get to a body to be susceptible to catching this disease?

[D]

It's pretty much physical contact with either a living sick person or a deceased person or their body fluids. So there've been cases where ambulance workers have acquired the infection while potentially cleaning the ambulance. After a case in the past where there's been body fluids around, the virus can get in through breaks in the skin and things like that. There is, which we didn't really realize at the start of the 2014 epidemic, but became clear, was that the virus can be spread sexually, particularly male to female. The virus can be shed in semen for many months after somebody's recovered from Ebola, which interestingly just learnt the other day, might also be the case for hantavirus. Ah, so there's a concern that a man could come into with very severe Ebola, be treated, recover, go home and then infect his female partner.

[C]

Paul, from what we know, most of the cases that have been identified have been in drc, the Democratic Republic of Congo.

[D]

Yes.

[C]

Tell us a bit about this region, the province in particular, where they're popping up and what we know about that area and why that might contribute to the spread of this disease.

[D]

Yeah, well, I've never been to that part of the Democratic Republic of Congo myself, although I've been fairly close across the border in Uganda, where we've got a project at the moment, it is an area where there have been continuing civil war for a number of years on and off. And indeed, recently there have been attacks against civilians. And in the past, certainly, we know that healthcare workers are often being targeted and health facilities also targeted by paramilitary groups. This causes a number of problems over and above the clearly the harm to human societies from having a war going on. The first is that it's actually very difficult in a war setting to get good surveillance to know what's going on. And I think people living in that part of DRC would be looking to Uganda as maybe a safe haven.

[C]

Right. So there's a lot of refugees, There's

[D]

a lot of refugee movement. And what we have seen in this epidemic is that people then present in Uganda with Ebola. The other issue is actually how do you get out to the areas? And again, when you've got an armed conflict going on, getting people out to care for these people and to spread the message about how to avoid Ebola is, again, difficult. When your workers are at risk of being murdered.

[C]

Yeah, of course. Is there any sense of how long you think this particular outbreak has been going? We know there were cases in April, but will this have been. Will this have begun much, much earlier than that?

[D]

I suspect it would have been, but I don't know for certain. If we had had adequate surveillance in place, we may well have seen cases cropping up maybe a month earlier.

[C]

Wow.

[D]

But I don't know that for certain. Ebola isn't actually that infectious as a disease, except when you have this very close physical contact. And so it does take time to build up the number of cases.

[C]

Why do you think it wasn't caught earlier? Why do you think the world wasn't alerted earlier to this outbreak's existence?

[D]

I think partly because difficulties in surveillance when you've got an armed conflict, surveillance in very poor countries is always more difficult than it is. You know, if you'd got a case in the uk, it would be kicked up very quickly. But in poor countries, surveillance systems don't work as well. And then when there's armed conflict, they often fall apart and you don't notice anything until you've actually got a significant problem. And I think that's part of the difficulty of working in these sorts of areas when you're dealing with diseases like Ebola.

[C]

The World Health Organization, now that it is aware of the problem, has moved very quickly. They've declared this a public health emergency of international concern. What exactly does that mean.

[D]

So it's partly a warning to others that this is happening and the WHO are concerned that it might spread. But it's also a request for countries to actually start trying to contribute to helping to bring this under control. And sometimes that is around provision of additional staff who are able and trained to deal with Ebola. Part of it is actually encouraging the delivery of equipment and facilities. We all in this country know about PPE personal protective equipment now since COVID And you need a lot of PPE to manage Ebola cases because every time you have a change of staff you have to change all the gear. And you can't use the same gear when you move from one patient to another. And so there is a huge resource needed to support an Ebola treatment center, particularly when you've got the number of cases that we seem to have got in drc.

[C]

Professor Hunter, just talk us through this particular type of Ebola. We have seen strains of Ebola before, but this one seems to be different. What do we know about it?

[D]

From what we've been told, this is due to the Bundibuya virus, which is one of six different species of Ebola virus. The commonest is Zaire virus, but this particular type tends to be found only really in eastern drc, western Uganda. It's somewhat less lethal than the more common Zaire virus. Maybe about one in three people will die compared to maybe about three quarters of people who die in the Zaire virus. The downside is that it doesn't seem to have a vaccine that's effective against it. The vaccine that we've got more widely is against the Zaire virus. And it's doubtful whether there is enough cross reaction between the Zaire virus and the Bundibuya virus to give satisfactory protection.

[C]

And what are the symptoms? What are the symptoms of this strain of Ebola?

[D]

Well, I don't think the symptoms vary much between the different species of Ebola other than their severity and their likelihood of death. Typically they start off fairly nonspecific with general flu like symptoms, fever. But the patient ultimately becomes more and more sick. They vomit, have diarrhea, they cognitive function deteriorates. The sort of the less they become more semi comatose. And typically with Ebola, which is why we call it one of the hemorrhagic fevers is they start bleeding from their orifices, their eyes, their mouth and their gut.

[C]

Has much work been done to find a vaccine for this particular strain or is that something that will be happening right now?

[D]

There are candidate vaccines against this variant. I don't think any of them are in clinical trial yet. But it won't be that difficult, in my view, to actually ultimately produce a vaccine against this species. The problem with vaccine development is that you tend to target the diseases that are more common, that there is likely to be a stronger market for the vaccine.

[E]

Yeah.

[D]

And there is often very little money to be made from vaccines against diseases that are actually quite rare.

[C]

If there isn't a working vaccine now, and as you say, the work is probably being done to try and find one. But you know, the clock is ticking and people are dying and the cases are mounting, what is the treatment plan? How do you contain a spread like this?

[D]

It goes down to identification, identification of cases. So the number one issue is identifying cases early enough before they've actually spread the infection onto somebody else and then getting those people into Ebola treatment centers where they can be nursed safely and then keeping them alive, hopefully till their body then manages to fight off the virus of their own accord. That's not always that easy. And we saw in West Africa, people would often think, I'm getting sick, I feel sick. If I go to the Biola treatment center, I'll die. And so they would abscond, go off into the bush, go back to their home village and spread the Ebola. And we saw in West Africa a lot of fake news, conspiracy theories which discouraged people from seeking care when they were getting sick.

[C]

Coming up, why has this outbreak escalated into a global health crisis? Why is it proving to be so hard to contain? And what can the international community do to stop the spread? That's in just a moment. And just a quick reminder, if you have any questions on this or any other story, do drop us a line to thestoryatthetimes.com and we'll try to answer as many of them as possible next week, when Luke and I will be presenting another Q and A episode on the last Thursday of the month. So do get in touch.

[B]

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[D]

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[C]

Paul, you've been talking us through this current outbreak of Ebola and some of your own experiences back in 2014, the last very big outbreak, the biggest outbreak we've seen. Talk us through a brief history of the disease. When did it first emerge? When was it sort of something that we picked up?

[D]

We first became aware of Ebola as a disease in about 1976, but that doesn't mean to say it wasn't around previously and almost certainly it has been around for decades, if not centuries before then. And since then. We typically see an outbreak every couple of years or something like that, and sometimes it's a single case and it sort of depends how you define outbreaks, how many cases you have to see before you say it's an outbreak rather than it's just an event. But I think most years there will have been at least a case that we that is happening somewhere, that's reported somewhere. And of course there's probably a lot of times when a case happens, somebody gets sick, they die, they haven't spread the disease to anybody else and nobody gets to hear about it.

[C]

I think most people would be quite surprised to hear how often you have outbreaks? Why is that? Why have there been so many outbreaks of Ebola?

[D]

I think it's getting worse. There are a number of issues going on here. I think one is population expansion. So what we're seeing is populations expanding into areas where they previously weren't. Roads are being built into pristine forest, and as soon as you build roads, people move along them, build settlements, build lives in those areas, and come into contact with animals that may not have actually been in contact with humans before, or at least not very often. And if those animals carry viruses like Ebola or mpox or Hantavirus, then the opportunities to spread that to humans increase. And I think that is a large part of it. And then, of course, climate change is adding to the destruction of habitats and increasing the proximity of people and animals as animals try and eke out livings in environments where they haven't normally occupied.

[C]

And given that there is a history of Ebola in this particular region in the drc, does that mean that the medical system in the country, the communities and their knowledge of how to deal with it, are they better prepared?

[D]

I think that they will certainly have experience. There is more than just experience about better prepared. There's resources, there's having people available who are continuing to work in those environments. And I think it's a balance between people with the experience are there, but there again, the resources might not well be. So even having really good, well trained doctors and nurses is not that much of an advantage where you've got no resources to protect yourself and build appropriate Ebola treatment centers.

[C]

Well, tell us about the response of the international community to this outbreak. What's needed? What do people need to do to step up to stop its spread?

[D]

Right. Well, I think that the key thing is availability of appropriate materials, personal protective equipment, and it's not just the hazmat suits that people wear, it's the sort of the infrastructure for the temporary hospitals themselves. And that almost certainly needs to be flown in and donated by the international community. There's the need for laboratory support in terms of diagnosis, confirmation, sequencing of the Ebola virus to try and track its spread and get some indication of where it's going, where it's come from, and hopefully where it's going. And some of that expertise may need to be provided by people outside the country. And I think as well, there is the potential for actually sufficient healthcare workers who are able to work in those sorts of environments. And it's not just the healthcare workers themselves, because even in hospitals in this country, you don't just need nurses and doctors, you need engineers, you need cleaners, you need people who can empty the latrines. And one of the things that I contributed to in 2014 was working out, trying to work out how long you could leave a latrine after it had been used by an Ebola patient before you could empty the latrine

[C]

without being at risk.

[D]

Yeah, absolutely, yes. Or at least where the risk is tolerably low. And all these things need to come together, the expertise, the people on the ground and the equipment. And I think that's what's needed. And that's what the World Health Organization will be trying to organize in the way it deals with talks to countries, particularly European countries within the World Health Organization. In the past, the Americas would provide a lot of resource and a lot of support in these contexts, but that's not necessarily the case anymore.

[C]

Well, as you say, this outbreak does come at a time where we're seeing huge aid cuts from the Trump administration in America. We've also had real cuts here in, in the UK in our foreign aid budget too. Does all of this cumulatively with Western governments wanting to shrink their aid budgets, is that having an impact on world health? I mean, does it mean that we're more likely to see diseases like this spreading?

[D]

Yeah, I think so. And I think it is a. I think it's a short sighted approach because ultimately there's two elements to my view about how you give aid in these sort of contexts. One is purely altruistic. You know, you see a need and you want to satisfy that need, but there's actually a very selfish reason as well, because these things can spread. Diseases can start in places, anywhere in the world, spread, and then, as we saw with COVID and then have huge impacts on your society and your economies. And ensuring that infectious diseases are identified and dealt with before they become international problems, not only is altruistic, but it's actually protecting yourself. And I think that's the big concern that many of us have over the sort of the cuts in AIDS that we've seen.

[C]

How equipped are we right now to be able to deal with these big infectious disease outbreaks?

[D]

I think on paper we're pretty good. But one of the depressing things around Covid was in about 2019, about a year before COVID happened, there was a big report summarizing how different countries were able to deal with a future pandemic. And the UK scored really highly. You know, and then the epidemic happened and we didn't, you know, we didn't do so well. So it's often very difficult to be absolutely certain about how well anybody is prepared for these situations really.

[C]

And Professor Hunter, as things stand, how much worse do you think this current outbreak could get?

[D]

I really have no idea. Once we see more get more information on the epidemic to date, then maybe that will start giving us some insight. But a few days, you know, a few weeks down the line, at a similar time for the West African epidemic, I don't think any of us would have expected it to become as big as it did infection. Infectious diseases are often very difficult to predict and we try, but as we saw with COVID it's not we don't always get it right. And typically, even when you do the modeling, sometimes the models can vary widely in how they predict the outcome. So yeah, I think you've got to hope that it won't get much worse, but prepare for if it does.

[C]

That was Paul Hunter, professor in Medicine at the University of East Anglia. The producers today were Michaela Arneson and Julia Webster. The executive producer was Tim Walklate and sound design and theme composition were by Maliceto. If you can do leave us a review wherever you get your podcasts. Thanks for listening. We'll be back tomorrow.

[B]

Foreign.

[A]

Hey everybody, it's Farnoosh Tarabi from the so Money Podcast. Today's episode is sponsored by Nerd Wallets, Smart Money Podcast, the show that breaks down financial decisions. With a team of trusted journalists, you'll get research backed insights and clear pros and cons. Whether you're planning a big purchase or just want to grow your wealth, they explain the why behind decisions like investing, home buying and choosing credit cards. With clear research backed insights, make your next financial move with confidence. Follow Nerd Wallet's Smart Money podcast on your favorite podcast app.

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