The Democratic Republic of the Congo (DRC)'s Ebola outbreak remains 'uncontrolled' despite a modest national decline in cases, the World Health Organisation (WHO) warned on Wednesday, 16 September, as the epidemic fractures into sharply diverging trajectories across affected provinces. With 7,258 confirmed cases and 3,510 deaths recorded through 13 September, the outbreak has already become the largest and deadliest in the DRC's history.

A Tale of Two Provinces

For much of the outbreak, the eastern province of Ituri has served as the primary epicentre, accounting for nearly 80 per cent of all confirmed cases. Infections there have been declining since mid-August, pulling the national caseload downward. Jean-Jacques Muyembe, a veteran Congolese virologist and head of the country's National Institute of Biomedical Research, said late Tuesday in Kinshasa that 'the peak is behind us (in Ituri). We are already on the downward slope,' citing 'a clear improvement' in Ituri's response.

However, the WHO cautioned that this national decline masks what it described as 'a pronounced geographic redistribution of transmission.' Over the most recent three-week period, confirmed cases fell by roughly 6 per cent nationwide — driven by a 25 per cent drop in Ituri — while cases in neighbouring North Kivu surged by more than 76 per cent.

North Kivu's Worsening Crisis

The WHO characterised the situation in North Kivu — the second-most affected province — as a 'sharp and sustained increase,' with the province recording its 'highest incidence' since the outbreak began. Unlike earlier flare-ups, the surge in North Kivu is broad-based rather than confined to isolated hotspots, according to the WHO.

North Kivu now accounts for approximately one-third of new cases and more than one-third of new deaths nationwide, increasingly offsetting the hard-won gains in Ituri. Muyembe cautioned that progress in some areas did not signal the epidemic's end, stressing the urgent need to strengthen contact tracing and other response measures across all affected zones.

Scale and Historical Context

The DRC government's latest situation report, covering data through 13 September, confirmed 7,258 Ebola cases and 3,510 deaths across 62 health zones in seven provinces. The current outbreak is now the second-largest Ebola epidemic globally, surpassed only by the 2014–2016 West Africa epidemic. Olivier le Polain, head of epidemiology and analytics for response at the WHO, told a UN briefing in Geneva on Tuesday that the high caseload and wide geographic spread meant it would take 'many, many months' to bring the outbreak fully under control.

Vaccine and Treatment Efforts

No vaccine or specific therapy has yet been approved for the Bundibugyo ebolavirus strain driving the current outbreak. Ervebo, a vaccine approved against Zaire ebolavirus, is being administered under a compassionate-use framework and research protocols to assess potential cross-protection. As of 13 September, 2,307 health and frontline workers had received the vaccine — roughly 20 per cent of the targeted group, according to the WHO.

Placide Mbala, Director of Research, Clinical Trials and Innovation at the Africa Centres for Disease Control and Prevention, said on Tuesday that laboratory findings and field observations had provided grounds to investigate possible cross-protection, but stressed these did not yet constitute proof. Clinical studies are now underway. Separately, 128 people had received investigational treatment or prophylaxis, including 16 confirmed patients and 112 high-risk contacts receiving post-exposure prophylaxis. The WHO-sponsored PARTNERS trial is evaluating the experimental monoclonal antibody MBP134, remdesivir, and their combination in confirmed patients. An initial analysis of the post-exposure prophylaxis trial could be available by the end of this month, Mbala indicated.

What Comes Next

Muyembe declined to set a new deadline for containing the outbreak, saying only that response teams should 'do everything possible so that we can celebrate the New Year under better conditions.' With the epidemic spanning 62 health zones and transmission intensifying in North Kivu even as Ituri stabilises, the path to containment remains long and deeply uncertain.