Authors: Mogsa DF, Kartika DP, Feny DH, Karyana M (Health Administrators of the Working Team for Policy and Strategy for Controlling Infectious Diseases and Environmental Health, Center for Health Security System Policy, BKPK, Ministry of Health, Republic of Indonesia)
Infectious disease outbreaks often give warning signs before they become a major crisis. These signs can include a rapid increase in cases, unusual deaths, health workers becoming ill, patients moving from one area to another, or the public losing trust in health workers. The Ebola outbreak in Central Africa exhibits these signs.
For Indonesia, this outbreak may feel far away. The Democratic Republic of Congo and Uganda are not in our region. However, in a world connected by international travel, trade, migration, and human mobility, local outbreaks can no longer be viewed as solely a single country's concern. A disease emerging in one region can become a global concern when there is a risk of cross-border spread.
Ebola is not a new disease. However, each time it emerges, it always teaches a harsh lesson. Ebola is rare, but it can be extremely deadly. It is not as easily transmitted as influenza or COVID-19, as it is not airborne like common respiratory illnesses. However, if patients are not identified quickly, isolated promptly, or health facilities are not prepared, Ebola can spread rapidly within families, health care facilities, communities, and border areas.
An Outbreak That Should Not Be Read as an Ordinary Local Occurrence
On 17 May 2026, WHO declared the Ebola outbreak due to Bundibugyo virus in the Democratic Republic of the Congo and Uganda as Public Health Emergency of International Concern (PHEIC). In simpler terms, a PHEIC stands for a public health emergency of international concern. This status is given when an event is deemed to have a risk of spreading across borders and requires global cooperation. The WHO emphasized that this situation does not yet meet the criteria for a public health emergency of international concern. pandemic emergency, but it is serious enough to raise global alarm.
This alert did not emerge suddenly. WHO received initial reports on May 5, 2026, of a high-fatality disease outbreak in Ituri Province, Democratic Republic of the Congo, including deaths among healthcare workers. On May 15, 2026, DRC health authorities officially declared the 17th Ebola outbreak in the country after laboratory tests confirmed Bundibugyo virus as the cause. As of May 16, 2026, WHO reported eight laboratory-confirmed cases, 246 suspected cases, and 80 suspected deaths in Ituri Province. Uganda also reported cases linked to travel from DRC.
These figures should be read carefully. Early in an outbreak, the number of reported cases often doesn't reflect the full situation on the ground. Some cases may not be detected. Some deaths may occur before patients can be tested. Some contacts may move before they can be tracked. Therefore, in an outbreak like Ebola, what matters is not just the current number of cases, but whether the system is able to detect subsequent cases quickly.
The Indonesian Ministry of Health has announced that no Ebola cases have been detected in Indonesia as of May 18, 2026. However, the Ministry of Health has increased surveillance at entry points and urged the public to remain vigilant following the WHO's declaration of a PHEIC status. This is the right step: not to panic, but not to wait.
Ebola Is Not a New Disease, but It Always Tests System Readiness
Globally, the WHO describes Ebola as a severe and often fatal disease. The average Ebola fatality rate is around 50%, although in previous outbreaks this figure has varied between 25% and 90%. This means that under certain conditions, out of 100 people infected with Ebola, about half can die—especially if diagnosis is delayed and treatment is not provided promptly.
Ebola symptoms are often initially nonspecific. A person may experience fever, weakness, muscle aches, headache, sore throat, vomiting, diarrhea, abdominal pain, rash, liver and kidney dysfunction, and in some cases, bleeding. The incubation period—the time from exposure to the virus to the appearance of symptoms—ranges from 2 to 21 days. Center for Disease Control (CDC-USA) explains that on average symptoms appear about 8 to 10 days after exposure.
This is where Ebola's greatest challenge lies. Early in the illness, patients may appear to have a common infection. Fever and diarrhea can be mistaken for a gastrointestinal infection. Body aches and weakness can be mistaken for the common flu. What differentiates them is their exposure history: whether the patient has recently returned from an outbreak area, had contact with a sick person, cared for a patient, touched a dead body, worked in a healthcare facility, or been exposed to blood and body fluids. These simple questions can determine whether a patient needs to be isolated and reported immediately.
Lessons from Global Numbers: A Small Outbreak Can Become a Major Crisis
The world paid a heavy price for the 2014–2016 West African Ebola outbreak. The outbreak began in Guinea and then spread to Sierra Leone and Liberia. The WHO recorded that by the end of the outbreak, more than 28.600 people had been infected and 11.325 had died. The outbreak also affected several other countries, including Nigeria, Senegal, Mali, Spain, the United Kingdom, Italy, and the United States.
Due to its high mortality rate, widespread public fear, and complex response requirements, Ebola could paralyze health services, disrupt routine services, undermine public confidence, and severely impact the economy. The World Bank estimates that under a “High Ebola” scenario, GDP losses in West Africa could reach US$7,4 billion in 2014 and US$25,2 billion in 2015. These figures demonstrate that Ebola is not just a health crisis, but can also destabilize economies through reduced employment, trade, investment, transportation, and public confidence.
The global lesson is clear: an outbreak should not be measured solely by the number of patients. It should also be measured by its impact on health systems, economies, public trust, and the country's ability to maintain essential services.
Bundibugyo: An Ebola Variant That Demands Greater Vigilance
The current outbreak is caused by Bundibugyo virus, a type of the virus that causes Ebola. This is important because not all Ebola strains have the same vaccines and therapies. The WHO notes that in the two previous Bundibugyo outbreaks, the mortality rate was in the range of 30–50%. The WHO also states that there is currently no licensed vaccine or specific therapy for Bundibugyo virus, although early supportive care can help save patients' lives.
The CDC also explained that the Ebola vaccine licensed in the United States is intended to prevent disease caused by Zaire ebolavirus, not Bundibugyo virus. This means that in a Bundibugyo outbreak, control cannot rely solely on mass vaccination. Control must revert to basic public health measures: early case detection, safe patient isolation, early treatment, contact tracing, safe burials, protection of healthcare workers, and building public trust.
An outbreak cannot be controlled by instructions alone. It requires trained personnel, available personal protective equipment, prepared laboratories, clear referral pathways, credible public messaging, and uninterrupted coordination. In other words, when pharmaceuticals and medical equipment are still limited, the quality of the system is crucial.
Health Facilities: Fortress or Transmission Point?
One of the warning signs in an Ebola outbreak is when healthcare workers become infected or die. This indicates that the system needs immediate self-evaluation. Was the first patient identified early? Were staff using personal protective equipment correctly? Were isolation rooms available? Was medical waste managed safely? Were room cleaning processes carried out according to standards? Were specimen collection and transport carried out without endangering staff?
Health facilities can be a haven of safety, but they can also become amplification points for transmission if infection prevention and control measures are not implemented. At the community level, other vulnerable points are home care and the handling of the dead. In many cultures, caring for the sick and handling the dead is a form of compassion. However, in the case of Ebola, the remains of patients can remain highly infectious. Health messages must be delivered with care and respect for local values. If communities feel disrespected, they may refuse the presence of health workers. When information is conflicting, hoaxes will spread faster than the health response.
Report Associated Press (AP) on May 21, 2026, demonstrated the importance of public trust in controlling an outbreak. In Bunia, residents burned down an Ebola treatment center following tensions over the handling of a body suspected of being Ebola-related. This incident underscored the importance of Ebola as a virus, not just a social trust issue.
Mobility, Conflict, and Borders: Why This Outbreak Is So Hard to Control
Ituri Province and its surrounding areas are not isolated. Trade, mining, cross-border travel, population movement, and security challenges exist. The WHO assesses that Ituri's location as a highly mobile region and its proximity to Uganda and South Sudan increase the risk of regional spread if strong cross-border coordination is not maintained.
In such a situation, a single unaccounted-for contact can travel to another region. A single patient can pass through several health facilities before being suspected of having Ebola. A single rumor can undermine public trust in the response team. Reuters reports that Ebola cases have also been confirmed in South Kivu, far from the initial epicenter in Ituri, and points to challenges in the response due to insecurity, mistrust, and limited resources. As the outbreak situation continues to evolve, the latest figures are subject to rapid change and official updates from the WHO and local health authorities should always be consulted.
This is why the Ebola outbreak needs to be read as a systems problem. Viruses do cause disease. But the spread of outbreaks is often determined by broader factors: slow disease monitoring, unprepared facilities, poor public communication, social conflict, delayed response funding, and weak cross-regional coordination.
Risk for Indonesia: Low Doesn't Mean Zero
Indonesia is not currently facing an Ebola outbreak. The Ministry of Health has stated that as of May 18, 2026, no Ebola cases have been detected in Indonesia. However, in public health terms, "no cases yet" should not be interpreted as "no need to prepare." In fact, the absence of cases is the best time to ensure the country's entry points, health facilities, laboratories, and reporting systems are ready to operate.
The Ministry of Health stated that it has strengthened surveillance at entry points, both at airports and seaports, especially for travelers from affected countries. The Ministry of Health has also alerted health workers, strengthened screening, prepared referral procedures, and integrated reports through the early warning system. Public Health Emergency Operations Center (PHEOC), as well as alerting national laboratories to support rapid detection.
For Indonesia, the focus of vigilance can be directed at travelers from affected areas or areas with active transmission. If within 21 days of travel, they develop fever, vomiting, diarrhea, body aches, weakness, or signs of bleeding, they should immediately contact a health facility and provide their travel history. This message is crucial because health workers can only properly assess risk if travel information is communicated honestly and promptly.
High Alert, Not Panic
Panic often makes outbreaks more difficult to control. When public fear is excessive, travelers can be stigmatized. If stigma increases, symptomatic individuals may conceal their travel history. If patients report their illness late, the chance of transmission increases. Therefore, public communication must maintain a balance: Ebola is a serious disease, but its transmission is preventable.
The message to the public should be simple:
- Ebola is not airborne like influenza; transmission occurs primarily through direct contact with the blood or bodily fluids of someone who is sick or has died from Ebola.
- People who are not yet symptomatic are generally not contagious.
- The risk increases if there is direct contact with the blood/body fluids of sick/deceased people.
- Don't panic, but don't be ignorant. Don't spread fear, but spread accurate information.
Lessons for Indonesian Health Resilience
For the BKPK, the Ebola outbreak in Central Africa offers an important policy lesson. Outbreak preparedness cannot be viewed solely as a technical matter for infectious diseases. It is a national health resilience agenda. It encompasses disease monitoring, health quarantine, laboratories, referral hospitals, health worker protection, public communication, emergency financing, and cross-sector coordination.
Indonesia needs to ensure that warning signs are recognized at entry points, forwarded to health facilities, tested by laboratories, and acted upon promptly. Health facilities should have a simple initial patient screening process: recognize symptoms, inquire about travel history, temporarily isolate if at risk, use personal protective equipment, report to health authorities, and refer patients according to procedures.
Protecting healthcare workers must also be a priority. Ebola demonstrated that healthcare workers are on the front lines of risk. Personal protective equipment, training on donning and doffing Personal Protective Equipment (PPE), simulations, supervision, waste management, patient referrals, and specimen transport are more than just a technical checklist. They are safety safeguards for healthcare workers and other patients.
Preparedness also requires public trust. Health systems cannot function alone if the public is afraid, confused, or distrustful. Therefore, public information must be clear, consistent, and humane. The public needs to know what Ebola is, how it is transmitted, when to seek help, and why honest travel history disclosure can save lives.
Don't Wait for the First Case
Ebola in Central Africa is a reminder that infectious disease threats don't always come with big warning signs. They can start with a fever that's considered normal, a death that's not immediately recognized, an exposed health worker, a contact missing from contact tracing, or a public that doesn't believe health messages. When all of these things happen together, an outbreak can transcend borders.
Indonesia does not need to panic. However, it cannot afford to be careless either. The WHO's global health emergency status should be read as a signal to heighten vigilance. The necessary steps are not an overreaction, but rather measured preparedness: monitoring travelers, alerting healthcare workers, a 21-day travel history-based screening process, temporary isolation rooms, personal protective equipment, laboratory referrals, public communication, and cross-sector coordination.
Ultimately, Ebola isn't just a story about a virus. It's a test of a health system's ability to recognize warning signs early. It's a test of whether health facilities are ready to protect healthcare workers. It's a test of a government's ability to convey information the public can trust. It's a test of a country's ability to act before a crisis escalates.
The most important message for Indonesia is that the outbreak may be far away, but the lessons are close. The risk may be low, but preparedness must not be low. Don't wait for the first case to become vigilant.
