Guest Opinion

Ebola has returned to West Africa, and this time the World Health Organization declared it a Public Health Emergency of International Concern (PHEIC) on May 17, 2026. During the last major outbreak in 2013-14, a PHEIC was not declared for nearly a year, despite many of the same warning signs.

The algorithm used to determine whether an outbreak qualifies as a PHEIC is part of the International Health Regulations. It is typically used to decide when a member nation should notify the WHO of an outbreak or case, and these same factors are considered when the WHO evaluates whether to issue a PHEIC declaration.

In remarks on May 19, 2026, the WHO Director-General said: “This is the first time a Director-General has declared a PHEIC before convening an Emergency Committee. I did not do this lightly.”

The Director-General appointed an Emergency Committee on May 20, 2026.

The mechanism for declaring a PHEIC was established under the International Health Regulations finalized in 2005. The rules gained momentum after the 2003 SARS outbreak in China, when Chinese authorities failed to report the novel respiratory virus quickly enough.

Since then, nine official PHEIC declarations have been made, including three related to Ebola outbreaks in Africa:

  • 2009-2010: H1N1 (“Swine Flu”) Influenza Pandemic
  • 2014-present: Poliomyelitis
  • 2014-2016: West Africa Ebola Epidemic
  • 2016: Zika Virus Epidemic
  • 2019-2020: Kivu Ebola Epidemic (Democratic Republic of the Congo)
  • 2022-2023: COVID-19 Pandemic
  • 2022-2023: Mpox Epidemic (Clade II)
  • 2024-2025: Mpox Epidemic (Clade I)
  • 2026-present: Ebola Epidemic [Ituri Province (Congo) & Uganda]

What Is Different About This Outbreak?

One major difference is the criticism directed at the West for its slow response to the 2013 outbreak. The conversation was often framed around “What is the risk to Europe?” rather than how to contain the disease in West Africa.

The Director-General’s decision to declare a PHEIC before even convening the committee reflected a sense of urgency and perhaps an awareness of past criticism over delays.

The WHO also pointed to another critical factor: the current outbreak involves the Bundibugyo strain of Ebola, a rarer strain for which there is no known vaccine or therapeutic treatment. During the 2013 outbreak there was also no approved vaccine, although experimental treatments were later authorized for emergency use after the PHEIC declaration.

The Slow Response in 2013

The West’s delayed response to the 2013 Ebola epidemic in West Africa remains controversial. A PHEIC was not declared until 2014. Another outbreak in the Democratic Republic of the Congo in 2018-19 also resulted in a PHEIC declaration due to its complexity and severity.

The first Ebola vaccine and therapeutic treatments emerged during the 2013-14 epidemic. Among them was ZMapp, an experimental therapy developed rapidly in response to the crisis.

Growing Vaccines in Plants — ZMapp

ZMapp was developed during the 2013-14 epidemic as researchers raced to find treatments for Ebola. As the virus spread through Guinea, Liberia, and neighboring countries, international efforts accelerated.

At the same time, distrust grew among West African communities toward Western governments and pharmaceutical companies, as well as toward their own governments.

Hundreds of U.S. scientists had already spent years researching possible Ebola vaccines and treatments. One promising biotechnology method involved reproducing cells in tobacco leaves. Kentucky Bioprocessing, a subsidiary of Reynolds America, was hired to grow the tobacco plants used in the process.

Although ZMapp had never been tested on human subjects, the FDA authorized it for emergency use on Ebola patients in October 2014 under an Emergency Use Authorization. The WHO also approved its use through its emergency public health protocol known as MEURI — Monitored Emergency Use of Unregistered and Investigational Interventions.

A 2017 book by Michael B.A. Oldstone and Madeleine Rose Oldstone, Ebola’s Curse, described the difficult decisions surrounding the treatment:

“Despite the danger of progressive disease as time passed, the health officials deliberated while considering that neither the antibody’s therapeutic effectiveness nor its side effects were known.”

The authors recounted how Dr. Sheik Humarr Khan, a leading Sierra Leone physician treating Ebola patients, was never informed that ZMapp was available, while American aid workers Kent Brantly and Nancy Writebol received the treatment in Guinea. Both survived.

During the 2018-19 Kivu Ebola outbreak in Congo, the WHO again approved ZMapp under the MEURI protocol. However, a newer therapeutic, REGN-EB3 developed by Regeneron, later proved more effective and eventually replaced ZMapp. In October 2020, it became the first FDA-approved Ebola treatment.

Final Thoughts

The urgency behind the WHO’s rapid declaration for the current Ebola outbreak in Congo and Uganda appears tied to one key difference from previous outbreaks: the Bundibugyo strain has no approved vaccine or therapeutic.

When the rest of the world asks whether Ebola could spread beyond Africa, the answer may determine whether global action comes quickly—or whether West Africa is again left waiting for help.

To read more articles by Professor Sutton go to:  https://profvictoria.substack.com/ 

Professor Victoria Sutton (Lumbee) is a law professor on the faculty of Texas Tech University. In 2005, Sutton became a founding member of the National Congress of American Indians, Policy Advisory Board to the NCAI Policy Center, positioning the Native American community to act and lead on policy issues affecting Indigenous communities in the United States.