Expand chart
Data: DRC Ministry of Health; Chart: Andrew Witherspoon, Harry Stevens/Axios

The long-simmering Ebola outbreak in the Democratic Republic of the Congo entered a new and more ominous phase this week, with the cross-border spread of a handful of cases into western Uganda.

Why it matters: The cross-border spread puts more pressure on the World Health Organization to declare the nearly yearlong outbreak a public health emergency, which it has proven reluctant to do. A committee will meet Friday to determine whether to take that step.

But, but, but: The international spread of Ebola was expected by health experts given the proximity of the outbreak areas in the DRC to the heavily trafficked border with Uganda.

  • Health authorities in Uganda had been vaccinating health workers in anticipation of seeing cases.
  • The overall trajectory of the outbreak remains unchanged, as health workers have been unable to break through community distrust and a violent insurgency inside the DRC.
  • The high percentage of cases that are community cases, ones in which health workers were not aware of infected people or the individuals they have come in contact with, is especially concerning.

Details: This Ebola outbreak is already the second largest on record, and even the deployment of a successful vaccine has proven insufficient at arresting its spread. A key reason for this is the challenging security environment in which responders are operating.

  • Health workers have been attacked and killed, and levels of community mistrust remain high in affected areas.
  • “Insecurity and community mistrust are a huge barrier, and we don’t have ready-made answers for dealing with either of those,” says Stephen Morrison, director of the Global Health Policy Center at the Center for Strategic and International Studies.

Health workers in the DRC and Uganda are conducting ring vaccination campaigns using a vaccine supplied by Merck known as the rVSV-ZEBOV vaccine.

  • But the vaccine is not sufficient for preventing all new cases and fatalities with so many community cases.
  • “The vaccine is not a silver bullet for this outbreak,” says Morrison.

The impact: Given the continued increase in cases in the DRC and the potential for additional spread into neighboring countries, health officials have expressed concern that the vaccine supply may run out in the next few months.

  • In May, a WHO advisory group recommended that the DRC offer lower doses of vaccines and to consider using other experimental vaccines to stretch supplies.

What we’re watching: Unlike the 2014–2016 West Africa epidemic, this one has skirted below the radar of world leaders. The appointment of a high-level UN coordinator with extensive security experience has raised hopes of a more robust response.

  • So far, the WHO has taken the lead in responding, sending hundreds of personnel to the region.
  • The CDC has just 15 experts in the DRC, but the security situation has kept them confined to cities away from the outbreak zones, an agency spokesman tells Axios.
  • Morrison and Jennifer Nuzzo, a senior scholar at Johns Hopkins Center for Health Security, say the U.S. and other nations need to reassess their contributions to stopping this outbreak.

The bottom line: On its present course, Morrison thinks the outbreak could persist for another 1–2 years. The longer it lasts, the greater the chance it has to reach major population centers.

Go deeper: Axios' complete Ebola outbreak coverage

Go deeper

Updated 2 hours ago - Politics & Policy

Coronavirus dashboard

Illustration: Sarah Grillo/Axios

  1. Health: Fauci says U.S. may not return to normal until 2022 — Trump's testing czar: Surge "is real" and not just caused by more tests
  2. World: Taiwan reaches a record 200 days with no local coronavirus cases
  3. Europe faces "stronger and deadlier" wave France imposes lockdown Germany to close bars and restaurants for a month.
  4. Sports: Boston Marathon delayed MLB to investigate Dodgers player who joined celebration after positive COVID test.

In pictures: Storm Zeta churns inland after lashing Louisiana

Debris on the streets as then-Hurricane Zeta passes over in Arabi, Louisiana, on Oct. 28. It's the third hurricane to hit Louisiana in about two months, after Laura and Delta. Photo: Sandy Huffaker/Getty Images

Tropical Storm Zeta has killed at least two people, triggered flooding, downed powerlines and caused widespread outages since making landfall in Louisiana as a Category 2 hurricane on Wednesday.

The big picture: A record 11 named storms have made landfall in the U.S. this year. Zeta is the fifth named storm to do so in Louisiana in 2020, the most ever recorded. It weakened t0 a tropical storm early Thursday, as it continued to lash parts of Alabama and the Florida Panhandle with heavy rains and strong winds.

3 hours ago - World

Taiwan reaches a record 200 days with no local coronavirus cases

Catholics go through containment protocols including body-temperature measurement and hands-sanitisation before entering the Saint Christopher Parish Church, Taipei City, Taiwan, in July. Photo: Ceng Shou Yi/NurPhoto via Getty Images

Taiwan on Thursday marked no locally transmitted coronavirus cases for 200 days, as the island of 23 million people's total number of infections reported stands at 550 and the COVID-19 death toll at seven.

Why it matters: Nowhere else has reached such a milestone. While COVID-19 cases surge across the U.S. and Europe, Taiwan's last locally transmitted case was on April 12. Experts credit tightly regulated travel, early border closure, "rigorous contact tracing, technology-enforced quarantine and universal mask wearing" and the island state's previous experience with the SARS virus for the achievement, per Bloomberg.

Go deeper: As Taiwan's profile rises, so does risk of conflict with China