North Kivu, Democratic Republic of the Congo · 25 June 2020 — The Minister of Health of the Democratic Republic of the Congo (DRC) declared the end of the Ebola Virus Disease (EVD) outbreak in North Kivu, Ituri, and South Kivu Provinces on 25 June 2020, closing the chapter on what was the country's longest Ebola outbreak and the second largest in recorded history, surpassed only by the 2014–2016 West Africa epidemic.
The declaration came more than 42 days — two full incubation periods — after the last person who contracted EVD in this outbreak tested negative twice and was discharged from care. It marked the culmination of a response that spanned nearly two years, operated amid armed conflict, community mistrust, and the simultaneous emergence of COVID-19.
The Scale of the Outbreak
The 10th EVD outbreak in DRC was first declared on 1 August 2018, following laboratory confirmation of a cluster of cases in North Kivu Province. Further investigations identified cases in Ituri and North Kivu with symptom onset dating back to May 2018. In 2019, the outbreak spread to South Kivu Province, and on 17 July 2019, the WHO Director-General declared it a Public Health Emergency of International Concern (PHEIC).
Over the course of the outbreak, more than 250,000 contacts of cases were registered across the three affected provinces. Thirty-three percent of cases (1,152/3,470) died outside of Ebola treatment centres, underscoring the challenge of reaching affected populations in time.
A Response Unlike Any Other
The response was led by the DRC Ministry of Health with support from WHO and partners across surveillance, contact tracing, laboratory services, infection prevention and control (IPC), clinical management, community engagement, and safe and dignified burials. What set this outbreak apart was the operating environment: eastern DRC is home to dozens of armed groups, and attacks against health workers and treatment facilities were a recurring feature of the response.
Despite these challenges, the response achieved several milestones:
- 11 field laboratories were established, testing up to 4,200 samples per week using GeneXpert PCR. Over 220,000 samples were tested in total.
- 11 Ebola Treatment Centres provided supportive care and life-saving therapeutics to 2,198 confirmed cases.
- An Ebola vaccine was licensed, and two treatments — REGN-EB3 (Regeneron) and mAB114 — were found to be highly effective. Of 305,841 people identified as eligible for vaccination, 99% (n=303,905) were vaccinated.
- A national survivor care programme was established in November 2018, providing clinical and psychological care and biological follow-up. Over 90% of survivors attended monthly follow-ups.
- More than 26,000 safe and dignified burials were performed (88% success rate) out of over 29,000 death alerts.
- Over 180 million screenings were conducted for Ebola symptoms at borders and points of control.
Surveillance in the Final Days
Even in the final weeks, the surveillance system maintained extraordinary intensity. From 17 to 23 June 2020, an average of 2,790 alerts were reported per day. Over 99% were investigated within 24 hours, and an average of 428 alerts were validated as suspected cases daily, each requiring specialised care and laboratory testing to rule out EVD. From 15 to 21 June alone, 3,219 samples were tested — including 2,665 blood samples from living suspected cases, 323 swabs from community deaths, and 344 samples from re-tested patients.
Figure: Confirmed and probable Ebola virus disease cases by week of illness onset by health zone. Source: WHO Disease Outbreak News, 26 June 2020.
The PHEIC Lifted
On 26 June 2020, the International Health Regulations (IHR) Emergency Committee convened and advised that the outbreak no longer constituted a Public Health Emergency of International Concern. The WHO Director-General accepted this recommendation, formally lifting the PHEIC designation that had been in place since July 2019.
WHO maintained the risk assessment as Moderate at the national and regional levels and Low at the global level, citing the ongoing risk of re-emergence from animal reservoirs or exposure to body fluids of survivors.
The Threat Is Not Over
The end of the outbreak declaration did not mean the end of risk. Ebola virus can persist in some body fluids of survivors for months, and in rare cases may result in secondary transmission or relapse — as was observed during this outbreak. Additionally, the virus is present in animal reservoirs in the region, meaning zoonotic spillover remains a constant threat.
The DRC entered a 90-day period of heightened surveillance following the declaration. The Consolidation and Stabilization Strategic Plan adopted by the Ministry of Health maintained enhanced surveillance, a long-term programme for survivor care, and other response mechanisms to ensure rapid detection of any new cases.
Lessons for Future Outbreak Responses
The 2018–2020 Ebola outbreak in eastern DRC produced several critical lessons for global health security:
- Community engagement is non-negotiable. The engagement of local leaders, communities, and survivors in care programmes and messaging played a central role in curtailing the outbreak. Where trust was absent, response efforts stalled.
- Conflict zones require adapted protocols. Standard outbreak response frameworks assumed a relatively stable operating environment. In eastern DRC, insecurity forced innovations in surveillance, vaccination delivery, and treatment access.
- Therapeutics and vaccines can be deployed in real-time. The deployment of an licensed vaccine (rVSV-ZEBOV) and the identification of two effective monoclonal antibody treatments during an active outbreak demonstrated that research and response can proceed simultaneously.
- Survivor care is part of the response. The national survivor care programme, with its monthly follow-ups and psychological support, became a model for addressing the long-term health consequences of Ebola.
Sources
- WHO Disease Outbreak News: Ebola virus disease – Democratic Republic of the Congo, 26 June 2020.
- WHO: 10th Ebola outbreak in the Democratic Republic of the Congo declared over.
- WHO: Statement on the meeting of the International Health Regulations (2005) Emergency Committee for Ebola virus disease in the Democratic Republic of the Congo on 26 June 2020.
- The East African: DR Congo declares end to Ebola outbreak.
- PMC/NIH: The 2018–2020 Ebola Outbreak in the Democratic Republic of the Congo.
- Oxford Open Forum of Infectious Diseases: Investigation of and Strategies to Control the Final Cluster of the 2018–2020 Ebola Virus Disease Outbreak.
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