Seven Strategies Implemented in Response to the 16th Ebola Virus Disease Outbreak in the Democratic Republic of Congo: Lessons Learned over a Three-Month Period
Abstract
1. Introduction
2. Methodology
2.1. Study Design
2.2. Sources
2.3. Analysis Framework and Complementary Qualitative Data
3. Results
3.1. Responses to the 3 Previous Ebola Outbreaks vs. The 16th Outbreak
3.2. Achievements, Benefits, and Factors That Enabled the Successful Response to the 16th Outbreak
- (a)
- Fourthly, as a crosscutting pillar, RCCE has been the backbone of IMS innovation in the 16th EVD epidemic in the DRC, supporting all seven pillars from the generation of increased surveillance alerts to motivating community participation in the IPC, case management, vaccination efforts, and research, and even supporting overall coordination.
- (b)
- RCCE’s support for IM and coordination: In mid-September 2025, the community was in turmoil, with several deaths and few successful recoveries among hospitalized patients. This resulted in increased resistance to case management uptake. There is a strong shared belief in traditional authorities and values in the Bulape community. Through mobilizing traditional leaders (heads of clans), the RCCE supported IMS coordination. The RCCE pillar facilitated a tacit deal, also called “the pact”, between the response coordination and the head of clans within the villages, who made a verbal commitment to work together to stop the spread of EVD within 6 weeks. The pact included agreed-upon mutual commitments and consideration of traditional leaders’ concerns during the response coordination. The leaders agreed to sensitize and motivate community members to facilitate engagement and improve health-seeking behavior through increased community alerts, identification of contacts, as well as greater Ebola vaccine demand. The response coordination commitment included improvement of the quality of case management, i.e., free treatment of other diseases and improved nutrition conditions within Ebola treatment and transit centers, taking into account the culturally accepted diet. Coincidentally, only a week after the agreement was established, the last case of EVD was discharged from the Ebola treatment center on September 25th. These practices also proved effective during the outbreak in West Africa [25].
- (c)
- RCCE supported both the surveillance and case management pillars, respectively, mainly through the increased community alerts and progressive healthcare uptake. Also, through community-based surveillance, the RCCE collaborated with the surveillance pillar’s scaling up of the training of Community health workers. Community engagement activities have promoted transparent communication about the care offered by ETCs, which has increased patients’ trust in and acceptance of health services.
- (d)
- Support for the vaccination pillar: The 16th EVD response has been recorded as one of the best, if not the best, with regard to ERVEBO vaccination uptake. The increased demand for vaccination uptake in Bulape health district is clearly the result of the RCCE sensitization efforts. In fact, the vaccination strategy shifted its focus from frontline workers to contacts (and contacts of contacts) in a geographical strategy, thanks to combined RCCE approaches that involved promoting the benefits of vaccination. Public awareness was raised through infodemic management strategies involving collaboration with experts from other domains; responding to community feedback and rumors was critical, and clear information about vaccines (side effects, efficacy, safety, etc.) was provided to gain the public’s trust.
- (e)
- RCCE support for IPC: As with surveillance, the presence of RCCE in the community supported the IPC in simplifying technical prevention messages to improve the uptake of public health measures and apply the recommended IPC measures, including safe and dignified burials.
- (f)
- The research pillar of the IMS has also been directly supported by the RCCE through the implementation of two distinctive Rapid Analysis Quality Surveys, at the beginning and towards the end of the response, and indirectly through supporting rapid assessments and studies within the community.
3.3. Challenges During the Response and the Possible Solutions
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Report of a WHO/International Study Team. Ebola haemorrhagic fever in Sudan, 1976. Report of a WHO/International Study Team. Bull. World Health Organ. 1978, 56, 247–270.
- Le Guenno, B.; Formenty, P.; Wyers, M.; Gounon, P.; Walker, F.; Boesch, C. Isolation and partial characterisation of a new strain of Ebola virus. Lancet 1995, 345, 1271–1274. [Google Scholar] [CrossRef] [PubMed]
- Towner, J.S.; Sealy, T.K.; Khristova, M.L.; Albariño, C.G.; Conlan, S.; Reeder, S.A.; Quan, P.-L.; Lipkin, W.I.; Downing, R.; Tappero, J.W.; et al. Newly discovered ebola virus associated with hemorrhagic fever outbreak in Uganda. PLoS Pathog. 2008, 4, e1000212. [Google Scholar] [CrossRef] [PubMed]
- Jahrling, P.B.; Geisbert, T.W.; Dalgard, D.W.; Johnson, E.D.; Ksiazek, T.G.; Hall, W.C.; Peters, C.J. Preliminary report: Isolation of Ebola virus from monkeys imported to USA. Lancet 1990, 335, 502–505. [Google Scholar] [CrossRef] [PubMed]
- CDC. Ebola. Outbreak History. Available online: https://www.cdc.gov/ebola/outbreaks/index.html (accessed on 1 December 2025).
- Henao-Restrepo, A.M.; Camacho, A.; Longini, I.M.; Watson, C.H.; Edmunds, W.J.; Egger, M.; Carroll, M.W.; Dean, N.E.; Diatta, I.; Doumbia, M.; et al. Efficacy and effectiveness of an rVSV-vectored vaccine in preventing Ebola virus disease: Final results from the Guinea ring vaccination, open-label, cluster-randomised trial (Ebola Ça Suffit!). Lancet 2017, 389, 505–518. [Google Scholar] [CrossRef] [PubMed]
- Sridhar, S. Clinical development of Ebola vaccines. Ther. Adv. Vaccines 2015, 3, 125–138. [Google Scholar] [CrossRef] [PubMed]
- Ebola Virus Disease Vaccines. Available online: https://www.who.int/news-room/questions-and-answers/item/ebola-vaccines (accessed on 1 December 2025).
- Dolzhikova, I.V.; Tokarskaya, E.A.; Dzharullaeva, A.S.; Tukhvatulin, A.I.; Shcheblyakov, D.V.; Voronina, O.L.; Syromyatnikova, S.I.; Borisevich, S.V.; Pantyukhov, V.B.; Babira, V.F.; et al. Virus-Vectored Ebola Vaccines. Acta Naturae 2017, 9, 4–11. [Google Scholar] [CrossRef] [PubMed]
- Bosa, H.K.; Kamara, N.; Aragaw, M.; Wayengera, M.; Katoto, P.D.M.C.; Ihekweazu, C.; Fallah, M.P.; Douno, M.; Agyarko, R.K.; Mbala, P.; et al. How to prepare for the next inevitable Ebola outbreak: Lessons from West Africa. Nat. Med. 2024, 30, 3413–3416. [Google Scholar] [CrossRef] [PubMed]
- Bullard, S.G. A Day-By-Day Chronicle of the 2013–2016 Ebola Outbreak; Springer International Publishing: Cham, Switzerland, 2018; ISBN 978-3-319-76564-8. [Google Scholar] [CrossRef]
- Houghton, F.T.; Houghton, S. Ebola Lessons for a Global Village: I am my brothers’ (and sisters’) keeper. Soc. Med. 2020, 13, 102–105. [Google Scholar] [CrossRef]
- World Health Association. La Flambée d’Ebola dans les Pays d’Afrique de l’Ouest ne Constitue plus une Urgence de Santé Publique de Portée Internationale. Available online: https://www.who.int/fr/news/item/29-03-2016-statement-on-the-9th-meeting-of-the-ihr-emergency-committee-regarding-the-ebola-outbreak-in-west-africa (accessed on 22 October 2025).
- Olabode, A.S.; Jiang, X.; Robertson, D.L.; Lovell, S.C. Ebolavirus is evolving but not changing: No evidence for functional change in EBOV from 1976 to the 2014 outbreak. Virology 2015, 482, 202–207. [Google Scholar] [CrossRef] [PubMed]
- Keita, A.K.; Koundouno, F.R.; Faye, M.; Düx, A.; Hinzmann, J.; Diallo, H.; Ayouba, A.; Le Marcis, F.; Soropogui, B.; Ifono, K.; et al. Resurgence of Ebola virus in 2021 in Guinea suggests a new paradigm for outbreaks. Nature 2021, 597, 539–543. [Google Scholar] [CrossRef] [PubMed]
- Giovanetti, M.; Grifoni, A.; Lo Presti, A.; Cella, E.; Montesano, C.; Zehender, G.; Colizzi, V.; Amicosante, M.; Ciccozzi, M. Amino acid mutations in Ebola virus glycoprotein of the 2014 epidemic. J. Med. Virol. 2015, 87, 893–898. [Google Scholar] [CrossRef] [PubMed]
- Yamaoka, S.; Ebihara, H. Pathogenicity and Virulence of Ebolaviruses with Species- and Variant-specificity. Virulence 2021, 12, 885–901. [Google Scholar] [CrossRef] [PubMed]
- Institut National de Sante Publique. Available online: https://insp.cd/ (accessed on 22 October 2025).
- Mwamba, D.K.; Mbuyi, D.; Ngbe, M.M.; Kayembe, J.-M.N. Leçons apprises de la gestion des épidémies de la maladie à virus Ebola en République Démocratique du Congo de 2007 à 2017. Ann. Afr. Méd. 2018, 11, e3018–e3031. Available online: https://anafrimed.net/lecons-apprises-de-la-gestion-des-epidemies-de-la-maladie-a-virus-ebola-en-republique-democratique-du-congo-de-2007-a-2017/ (accessed on 22 October 2025).
- Mwamba, D.; Mboussou, F.; Akilimali, P.; Ngandu, C.; Impouma, B.; Ihekwazu, C.; Kamba, S.R.; Janabi, M.Y. New Ebola virus disease outbreak in the Democratic Republic of the Congo: Early response guidance. Lancet 2025, 406, 1557–1558. [Google Scholar] [CrossRef] [PubMed]
- CDC. Emergency Operations Centers and Incident Management Structure. Available online: https://www.cdc.gov/field-epi-manual/php/chapters/eoc-incident-management.html (accessed on 22 October 2025).
- World Health Organization. Operations. Available online: https://www.who.int/emergencies/operations (accessed on 22 October 2025).
- Gebru, G.N.; Henderson, A.K.; Elduma, A.H.; Squire, J.S.; Vandi, M.A.; Moffett, D.; Foster, M. The crucial role the field epidemiology training program played in preparedness and response to the COVID-19 pandemic in Sierra Leone, January 2020 to August 2022. Front. Public Health 2025, 13, 1566824. [Google Scholar] [CrossRef] [PubMed]
- World Health Organization. Infection Prevention and Control Guideline for Ebola and Marburg Disease, August 2023. Available online: https://www.who.int/publications/i/item/WHO-WPE-CRS-HCR-2023.1 (accessed on 29 October 2025).
- Gillespie, A.M.; Obregon, R.; El Asawi, R.; Richey, C.; Manoncourt, E.; Joshi, K.; Naqvi, S.; Pouye, A.; Safi, N.; Chitnis, K.; et al. Social Mobilization and Community Engagement Central to the Ebola Response in West Africa: Lessons for Future Public Health Emergencies. Glob. Health Sci. Pract. 2016, 4, 626–646. [Google Scholar] [CrossRef] [PubMed]
- Muyembe, J.-J.; Pan, H.; Peto, R.; Diallo, A.; Touré, A.; Mbala-Kingebene, P.; Bateyi Mustafa, S.H.; Tambwe, N.; Mulangu, S.; Ahuka-Mundeke, S.; et al. Ebola Outbreak Response in the DRC with rVSV-ZEBOV-GP Ring Vaccination. N. Engl. J. Med. 2024, 391, 2327–2336. [Google Scholar] [CrossRef] [PubMed]
- Jaspard, M. La Recherche Opérationnelle sur les Maladies Infectieuses à Potentiel Épidémique et Menaçant en Afrique Sub-Saharienne. Ph.D. Thesis, University of Bordeaux, Bordeaux, France, 2022. [Google Scholar]
- Gostin, L.O.; Katz, R. The International Health Regulations: The Governing Framework for Global Health Security. Milbank Q. 2016, 94, 264–313. [Google Scholar] [CrossRef] [PubMed]
- Munster, V.J.; Bausch, D.G.; de Wit, E.; Fischer, R.; Kobinger, G.; Muñoz-Fontela, C.; Olson, S.H.; Seifert, S.N.; Sprecher, A.; Ntoumi, F.; et al. Outbreaks in a Rapidly Changing Central Africa—Lessons from Ebola. N. Engl. J. Med. 2018, 379, 1198–1201. [Google Scholar] [CrossRef] [PubMed]
- Hamilton, K. The Politics of Fear: Médecins Sans Frontières and the West African Ebola Epidemic. Emerg. Infect. Dis. 2017, 23, 1934. [Google Scholar] [CrossRef]
| Strategies | EVD Management According to the IMS Model | Old EVD Management Model |
|---|---|---|
| Thorough retrospective and prospective investigation. | Involvement of all pillars * whose interventions were carried out in the community. This helped improve investigations. | Investigations performed solely by the oversight committee ^. Interventions were conducted in silos, which delayed investigations. |
| Strengthening infection prevention and control (IPC) measures in the community. | The interventions were conducted in cooperation with the political and administrative authorities, together with the security services. This helped to inspire community support. | Security services were not systematically involved in community interventions, leading to considerable resistance. |
| Holistic case management provided by experienced staff. | In addition to involving expert and experienced human resources, we established sub-pillars of blood transfusion and animal care and integrated them into holistic treatments, improving the quality of care. A One Health approach was considered. With regard to animal care, in addition to advising the community not to consume animals found dead or undercooked meat, veterinarians were called in to provide better care. | The animal care subcommittee was not established, and the blood transfusion subcommittee was not considered as such. This led to negligence in the control of reservoirs and vectors. |
| Strengthening risk communication and community engagement (RCCE). | Close collaboration between the RCCE, surveillance, and other pillars facilitated the prompt implementation of operational interventions, such as raising awareness among the community and enhancing community engagement from the local political administration and traditional and religious leaders, as well as other key local influencers such as village musicians. This helped to foster community buy-in. | The collaboration between the RCCE and other pillars was not as strong as during the last outbreak, and preventative measures taken in collaboration between the RCCE pillar and other pillars were not as effectively synchronized as during that recent outbreak. |
| Ring vaccination. | The availability of real-time data in the national health information database facilitated the monitoring and refocusing of interventions. This enabled the monitoring of the vaccination strategy. | Vaccination data was not stored in the national database, making it difficult to effectively monitor vaccination coverage with respect to targets. |
| Operational research. | Spontaneously provided clarification based on evidence, using quantitative, qualitative, and mixed approaches. | The research commission was not an integral part of the coordination of the response, structurally or systemically. Each commission had its own small unit, with only a limited ability to conduct advanced analyses. This delayed the implementation of the “action research” approach. |
| Anchoring interventions in the system. | Better coordination around the incident manager (IM) through pillar and section managers with the involvement of TFPs enabled alignment with the system and the elimination of duplicate responders and interventions. The implementation of an accreditation system prior to deployment in the field and effective monitoring of responders and interventions were deemed effective. | There was no accreditation system for human resources deployed in the field. This limited the effective monitoring of responders and interventions. The consequences were non-alignment with the system, duplication, and inefficient use of resources. |
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Share and Cite
Mwamba, D.K.; Angendu, K.B.; Diouf, W.; Mikobi, M.-C.; Leonard, O.; Kalala, D.; Ntumba, N.; Kakule, D.; Kayembe, D.K.; Sana, E.; et al. Seven Strategies Implemented in Response to the 16th Ebola Virus Disease Outbreak in the Democratic Republic of Congo: Lessons Learned over a Three-Month Period. Viruses 2026, 18, 28. https://doi.org/10.3390/v18010028
Mwamba DK, Angendu KB, Diouf W, Mikobi M-C, Leonard O, Kalala D, Ntumba N, Kakule D, Kayembe DK, Sana E, et al. Seven Strategies Implemented in Response to the 16th Ebola Virus Disease Outbreak in the Democratic Republic of Congo: Lessons Learned over a Three-Month Period. Viruses. 2026; 18(1):28. https://doi.org/10.3390/v18010028
Chicago/Turabian StyleMwamba, Dieudonné K., Karl B. Angendu, Waly Diouf, Marie-Claire Mikobi, Olive Leonard, Danny Kalala, Nella Ntumba, Deogratias Kakule, David K. Kayembe, Emilia Sana, and et al. 2026. "Seven Strategies Implemented in Response to the 16th Ebola Virus Disease Outbreak in the Democratic Republic of Congo: Lessons Learned over a Three-Month Period" Viruses 18, no. 1: 28. https://doi.org/10.3390/v18010028
APA StyleMwamba, D. K., Angendu, K. B., Diouf, W., Mikobi, M.-C., Leonard, O., Kalala, D., Ntumba, N., Kakule, D., Kayembe, D. K., Sana, E., Kabasele, B., Katya, J., Montoyo, A., Serra, B., Bulambo, H., Otshudiema, J., Kapanga, S., Balayulu, O., Muya, J., ... Akilimali, P. Z. (2026). Seven Strategies Implemented in Response to the 16th Ebola Virus Disease Outbreak in the Democratic Republic of Congo: Lessons Learned over a Three-Month Period. Viruses, 18(1), 28. https://doi.org/10.3390/v18010028

