African health ministers have agreed to keep their countries' borders open while strengthening surveillance and cross-border cooperation as an Ebola outbreak in the Democratic Republic of Congo (DRC) continues to spread, with more than 10,000 confirmed cases and nearly 5,000 deaths.
The decision followed an emergency virtual meeting convened by the Africa Centers for Disease Control and Prevention (Africa CDC), attended by more than 40 health ministers who discussed ways to contain the outbreak caused by the Bundibugyo strain of the Ebola virus.
The meeting agreed that countries should prepare their health systems for potential infections, coordinate their responses and closely monitor cross-border movements rather than impose widespread border closures.
Africa CDC Director-General Jean Kaseya warned that the continent was falling behind in its efforts to contain the outbreak, which has a case fatality rate of 48.5%, according to the agency.
"I stood before more than 40 African ministers and said what the data tells us: We are not winning so far," Kaseya said.
"Together, we agreed to prepare every country, coordinate across our borders and keep those borders open while watching them closely. Our partners are standing behind Africa's plan."
Kaseya said the outbreak had evolved over five months from a national emergency into a continental health security challenge, with insecurity, humanitarian crises and limited funding complicating containment efforts.
Uganda's Health Minister Chris Baryomunsi said his country's experience showed that early detection and decisive action could interrupt transmission.
Uganda was declared free of Ebola by the World Health Organization (WHO) in August after reporting 20 confirmed cases following the outbreak's declaration in May.
The Africa CDC has identified 10 other countries at risk, including Rwanda, Kenya, Tanzania, Angola, Burundi, the Central African Republic, the Republic of Congo, Ethiopia, South Sudan and Zambia.
The outbreak has surpassed 10,170 confirmed cases, making it the second-largest Ebola epidemic on record. Some experts fear it could eventually overtake the 2014-2016 West African outbreak, which infected about 28,000 people and killed more than 11,000.
Although researchers disagree over whether the current epidemic will reach that scale, they warn that the risk of further international spread will increase unless transmission in the DRC is brought under control.
The country is reporting between 400 and 500 new confirmed infections each week, with numbers remaining relatively stable.
Dr. Boghuma Titanji, an infectious disease specialist at Emory University, said the figures offered limited encouragement because infections were neither rising exponentially nor declining.
One major obstacle is the difficulty of tracing contacts and securing cooperation from affected communities. Health workers have sometimes spent more time persuading residents to cooperate than providing medical assistance.
Fewer than a quarter of new cases involve people already identified as contacts of infected individuals, suggesting that numerous transmission chains remain undetected.
France, Kenya, Nigeria and Uganda have also reported cases linked to the outbreak, with approximately 30 confirmed infections recorded outside the DRC.
Justin Lessler, a University of North Carolina researcher who studies infectious disease outbreaks, said the direct threat to the United States remained extremely low but warned that countries with fragile health systems could face greater difficulties.
South Sudan, particularly vulnerable because of conflict and humanitarian challenges, is among the countries of concern.
Ebola spreads through direct contact with the bodily fluids of infected people, including blood, vomit and semen. Controlling transmission therefore requires effective isolation, contact tracing and infection prevention measures.
The current outbreak has been particularly difficult to contain because it is caused by the Bundibugyo virus, a strain related to but distinct from the Ebola virus responsible for most previous epidemics.
Initial diagnostic testing was primarily designed to detect the more familiar Ebola virus, delaying recognition of the strain behind the current infections. Although the outbreak was declared in May, medical evidence suggests transmission had begun months earlier.
Armed conflict, weaknesses in health systems, community mistrust, misinformation and reductions in international aid have further complicated the response.
Katie Thomas-Canfield, the International Rescue Committee's Ebola response director, said working directly with affected communities was essential to breaking transmission chains.
Dr. Wendy Armstrong, president of the Infectious Diseases Society of America, warned that the outbreak remained far from being controlled and could deteriorate further.
Experts expect transmission to continue through the end of the year, although vaccine development offers hope for 2027. Several candidates are being tested against the Bundibugyo strain, and Titanji said she was optimistic an effective vaccine could become available within the next 12 months.
Meanwhile, researchers are updating projections to assess how the epidemic could develop.
In May, the U.S. Centers for Disease Control and Prevention (CDC) published computer-generated scenarios estimating that infections could reach between 10,000 and more than 20,000 over three months. The agency is updating its projections but declined to make scientists available to The Associated Press (AP) to discuss the latest trends.
Alessandro Vespignani, a disease modeler at Northeastern University, said weekly infections had yet to decline enough to signal meaningful progress.
He said there had not been the kind of "decay in the number of cases weekly that we need to see the light at the end of the tunnel."