Dr. Tyler Evans on Critical Lessons From the Frontlines of Ebola

By Ajong Mbapndah L

As the Democratic Republic of Congo grapples with what has already become the third-largest Ebola outbreak on record, fresh concerns are emerging about whether the world has once again been caught unprepared for a crisis experts have long warned could happen.

For Dr. Tyler B. Evans, the current outbreak is more than another public health emergency. It is evidence of deeper structural failures that have weakened global disease surveillance and response systems at a time when infectious disease threats are becoming increasingly interconnected.

An infectious disease specialist with nearly three decades of experience in global health, Dr. Evans worked on the frontlines of the two largest Ebola outbreaks in modern history — in Sierra Leone during the devastating 2014-15 West African epidemic and in the Democratic Republic of Congo during the 2018-20 outbreak. His experience places him among a small group of experts who have witnessed firsthand both the successes and shortcomings of international outbreak responses.

In this interview with Pan African Visions, Dr. Evans argues that the current Ebola crisis cannot be viewed in isolation. He describes the convergence of Ebola and Hantavirus threats as part of a growing “syndemic” — a dangerous collision of multiple health emergencies amplified by fragile health systems, underfunded surveillance networks, conflict, displacement, and declining investments in preparedness.

Drawing on lessons from Sierra Leone and the DRC, Dr. Evans explains why delayed detection remains one of the greatest threats to global health security, assesses the response by African and international institutions, and outlines what governments must do now to prevent a containable outbreak from becoming a far larger regional crisis.

His warning is stark: outbreaks do not become emergencies because viruses suddenly become more dangerous. They become emergencies when societies neglect the systems designed to detect and stop them before they spread.

You have worked on the two largest Ebola outbreaks in history, in Sierra Leone and the DRC. From your experience, how does the current outbreak compare, and what concerns you most at this stage?

I was in Sierra Leone in 2015, during the West African epidemic, the largest in history. I later worked the response in the eastern DRC, in the South Kivu area, during the North Kivu epidemic, which was the second largest. So I have seen both ends of the scale.

The virus has not changed. What has changed is the system around it. In 2015 and 2019, the world was leaning in. Resources were flowing, even if late and imperfect. This time the outbreak grew to several hundred cases before it was confirmed. That is the part that concerns me. An outbreak of this size going undetected in the most Ebola-experienced country on earth is not a story about the pathogen. It is a story about what we dismantled before the pathogen arrived.

The outbreak reportedly went undetected for several weeks before being confirmed. How significant was that delay, and what does it reveal about the current state of surveillance and outbreak preparedness in Africa?

The delay is the most important fact of this outbreak. Surveillance is not a mystery. It is logistics. It is moving a blood sample from a remote health zone to a lab in Kinshasa without it degrading on the way. It is community health workers who know what to look for and have a phone with credit to report it. It is a lab that can sequence the virus quickly. In this outbreak, testing began in late April, and samples were delayed and in some cases spoiled in transit. That is a capacity failure, not bad luck.

What it reveals is that a good deal of that capacity in the region was funded externally, and much of it thinned in 2025. When you remove the people and the supply chains that detect outbreaks early, you do not get fewer outbreaks. You get later ones, which are larger and harder to stop.

Drawing on nearly three decades of global health experience, Dr. Tyler Evans is calling for renewed investment in disease surveillance and preparedness.

This outbreak involves the Bundibugyo strain of Ebola, for which there is no approved vaccine. How does that change the response strategy compared to previous outbreaks involving the Zaire strain?

For the Zaire species, we now have a licensed vaccine and monoclonal antibody treatments. Those tools changed the math, but Bundibugyo has neither.

So the strategy reverts to the fundamentals that worked before any of those products existed. Case finding. Isolation. Contact tracing. Infection prevention and control. Safe and dignified burials. Early supportive care, because fluids and basic management save lives even without a specific drug.

This is exactly what I leaned on in Sierra Leone in 2015, before the Zaire vaccine became a game changer. The absence of a vaccine does not leave us helpless. It means the non-pharmaceutical fundamentals have to be close to flawless, and that those fundamentals depend entirely on the surveillance and trust we were just discussing.

You have described the current situation as a “syndemic” rather than simply an outbreak. What do you mean by that, and why does that distinction matter for policymakers and health authorities?

A syndemic, a term we owe to the medical anthropologist Merrill Singer, is what happens when two or more conditions cluster in a population and interact, amplified by the social and structural environment, so the combined burden is worse than the sum of its parts.

Ebola in eastern DRC is not a standalone event. It is sitting on top of armed conflict, mass displacement, malnutrition, measles, mpox, a fragile health system, and now a withdrawal of external support. The virus is the spark. The structural conditions are the accelerant.

The distinction matters because of where it points your resources. If you treat this as only an outbreak, you fight the virus and leave the conditions intact. The conditions then produce the next outbreak. Policymakers who understand it as a syndemic invest in the underlying system, not just the emergency in front of them.

The concern is not that Ebola becomes the next COVID-19. The concern is that we allow a containable disease to become uncontained, says Dr. Tyler Evans

Ebola outbreaks seem to recur regularly in the Democratic Republic of Congo and, to a lesser extent, Uganda. Why do these countries remain particularly vulnerable, and what underlying factors continue to drive these outbreaks?

There is an ecological answer and a structural one. The ecological answer is the reservoir, the spillover at the forest interface. That explains where the virus comes from. It does not explain why it spreads.

The structural answer explains the spread. Conflict in the east. Displacement. Mining and trade that move people across borders. Thin health infrastructure. And distrust, which is the one people underestimate.

When I worked in the South Kivu area in 2019, I was struck by the violence against health workers who were only trying to help. People did not see helpers. They saw figures in Tyvek suits, looking extraterrestrial, taking relatives into treatment units from which roughly half returned. There was no trust, because there had been no system worth trusting. These are governance and equity problems wearing an epidemiological mask.

You have argued that cuts to USAID and the dismantling of parts of the CDC’s global health infrastructure contributed to delayed detection. How significant has the impact of these funding cuts been on the current outbreak response?

I want to be careful here, because single-cause claims about one outbreak are hard to prove cleanly. But the mechanism is concrete, and the timing is not a coincidence.

USAID historically supported the unglamorous parts of detection in DRC, including the transport of samples for testing. Surveillance networks were funded in significant part by USAID grants. Across 2025 those grants were cancelled or cut, the networks thinned, and experienced community health workers moved on to other work. The US also stepped back from the WHO, which degraded the information channels that flag outbreaks early. Former USAID officials and the WHO team in DRC have all pointed to the same gap.

So the funding decisions did not create the virus. They removed the scaffolding that would normally have caught it early. We are not only slow to respond this time. We took out the smoke detector before the fire.

The concern is not that Ebola becomes the next COVID-19. The concern is that we allow a containable disease to become uncontained., says Dr. Tyler Evans

How do you assess the response so far from the DRC and Ugandan governments, Africa CDC, and the WHO? What have they done well, and where do you believe improvements are urgently needed?

Once the outbreak was confirmed, the institutional response moved quickly. WHO declared a public health emergency of international concern within two days. Africa CDC declared a continental emergency the day after. Rapid response teams deployed, partners like MSF, UNICEF, and the Red Cross mobilized, and Uganda activated screening and surveillance fast after its imported cases.

DRC has institutional muscle memory. This is its 17th outbreak, and that experience is real. But experience is not the same thing as capacity. The knowledge of how to stop Ebola does not catch an outbreak early on its own. It needs the people and the supply chains that the knowledge runs on, and those have been cut.

So the real gaps sit before and beneath that fast response. Detection failed upstream, before any of the machinery could engage. And on the ground, in active conflict zones, response teams cannot reach communities without security and trust. Africa CDC taking a leading role is the right direction, an African-led response to an African emergency. But it needs durable financing, not a borrowed-time scramble that resets to zero the moment cases stop.

Some conferences have been cancelled and there have been calls for travel restrictions. Based on what we know today, are such measures justified, or do they risk creating unnecessary panic and economic disruption?

We have evidence on this. During the West African epidemic, the largest on record, with transmission in major cities, only a small number of cases were ever exported to Europe, most of them planned medical evacuations.

Ebola spreads through direct contact with bodily fluids, not casual or airborne transmission. Targeted exit screening at airports in affected areas is sensible. Blanket travel bans and the cancellation of conferences far from the epicenter generally are not, on today’s evidence. They impose real economic cost, and they create a perverse incentive, because countries learn that honest, early reporting gets them punished with isolation. The measures that feel protective often make the next outbreak harder to detect.

At the moment, how concerned should Africa and the wider world be about this outbreak? Is there a realistic risk of a broader regional or international public health emergency?

I would calibrate it honestly. Regionally, this is serious. It is already a continental emergency. Cases are concentrated in Ituri and North Kivu, there has been a case in Goma, the virus has crossed into Uganda, and conflict is limiting access in exactly the places that need it most.

Globally, the risk is lower. The historical fatality rate for Bundibugyo is high, and there is no vaccine, but the transmission route makes it containable with the fundamentals. The realistic danger is regional escalation if conflict keeps responders out, not a global pandemic.

The concern is not that Ebola becomes the next COVID-19. The concern is that we allow a containable disease to become uncontained because we took apart the means to contain it

The latest Ebola outbreak has reignited debate about preparedness, funding, and the resilience of Africa’s public health systems.

Between outbreaks, what practical steps should African countries be taking to strengthen preparedness, improve early detection, and reduce the risk of future Ebola epidemics?

Invest in the boring infrastructure, and keep it standing between outbreaks rather than switching it on after cases appear.

That means retaining community health workers, not laying them off so they end up driving taxis in Kinshasa, then trying to recruit them back mid-crisis. It means reliable sample transport, decentralized laboratory capacity, and genomic sequencing close to where outbreaks start. It means pre-positioned infection control supplies. And it means building community trust before the emergency, not during it.

The financing has to be durable and African-led, so that detection does not depend on the priorities of any single foreign administration. Surveillance is a standing capacity. It is not a switch you flip when the cases are already counting in the hundreds.

Looking back at the lessons from West Africa in 2014-15 and the DRC outbreak in 2018-20, what are the biggest mistakes the world risks repeating today?

There is a recurring pattern. We treat each outbreak as an emergency to be funded reactively, then defund the response the moment the cases stop, and act surprised when the next one arrives.

West Africa taught us that a late and fragmented international response, layered on broken community trust, lets a containable disease explode. The DRC in 2018 to 2020 taught us something harder. You can have vaccines and still fail if communities do not trust the people delivering them. I saw that distrust firsthand in the South Kivu area.

Today we risk repeating both of those at once, with a new mistake added on top. This time we dismantled the detection scaffolding before the outbreak even began. That is the lesson we seem most determined not to learn.

If you could deliver one message to African leaders, international donors, and global health institutions about the current outbreak, what would it be?

Outbreaks tests of the systems we choose to build or neglect. The virus will always find the gap we leave for it. So invest in the unglamorous, standing capacity, African-led and durably financed, before the next spark and not after. We know exactly what works. The only open question is whether we are willing to pay for it when no one is watching.