Closing Critical Gaps in the 2026 Bundibugyo Ebola Response: Five Actionable Priorities.

The 2026 Bundibugyo virus disease (BDBV) outbreak in the Democratic Republic of the Congo and adjacent Uganda has revealed major deficiencies in outbreak response. The available diagnostics, vaccines, and therapies were primarily designed against Zaire Ebola virus - leaving us ill-prepared for BDBV detection and control. We call for five immediate actions to strengthen existing efforts. First, rapidly establish a decentralized three-tier molecular diagnostic network to allow timely detection and genomic surveillance. Second, since there are few approved treatments that target BDBV specifically, adaptive platform trials should assess the potential of repurposed host-directed therapies. Third, in conflict-affected settings, routine enabling environment data collection to strengthen surveillance is needed, whilst digital proximity tracing and social support mechanisms, such as community tracing collaborative (CTC) responses to combat community transmission through contact identification and isolation, would also add value. Fourth, ring vaccination strategies with recombinant vesicular stomatitis virus-Zaire Ebola virus (rVSV-ZEBOV) as a post-exposure intervention should be explored, given the potential for cross-protection against BDBV. Fifth, implementation of extensive genomic surveillance should be enhanced to differentiate between continuous human transmission and sporadic zoonotic spillover events while informing ecology-based control strategies. Together, these recommendations highlight actionable, scalable steps that can be implemented quickly through existing systems and out-of-the-box solutions. Filling these key gaps could significantly affect the outcome of this current outbreak and enhance regional and global preparedness for future ebolavirus outbreaks.