As a new outbreak of Ebola spreads across eastern Congo, those who survived the devastating 2018-2020 epidemic are sounding alarms about familiar obstacles that could hamper the response. The memories of that catastrophic period resurface whenever Vianney Kambale Kombi reflects on his experience in Beni, a major commercial centre near the Uganda-Rwanda border, where he contracted the virus and witnessed the disease claim thousands of lives. Between 2018 and 2020, the Ebola outbreak in Congo became the second-largest in history, with more than 3,400 confirmed cases and over 2,200 deaths before vaccines helped bring the outbreak under control. Now, as the Democratic Republic of Congo grapples with a fresh crisis driven by the rare Bundibugyo virus strain, survivors worry that the same patterns of denial and mistrust that accelerated transmission during the previous outbreak could derail containment efforts once again.
The core challenge that prolonged the 2018-2020 outbreak was not the virus itself but the refusal of many communities to acknowledge its existence or accept medical solutions. Kombi describes how his own community rejected the scientific reality of Ebola, instead attributing the disease to supernatural causes. "We thought it was witchcraft," he explains, capturing a widespread belief that undermined public health messaging and prevented people from seeking treatment. This cultural interpretation of illness was not merely a curiosity but a significant barrier to stopping transmission. When communities believe a disease is caused by spiritual forces rather than a pathogen, they turn to traditional healers and folk remedies rather than isolation and medical care, creating perfect conditions for the virus to spread rapidly through contact with the sick.
Parallel to these supernatural interpretations ran another equally destructive narrative—that Ebola was a Western fabrication designed to generate funding and expand external influence in Congo. Some residents viewed the outbreak through a lens of conspiracy and political manipulation, seeing the disease not as a biological threat but as a tool wielded by international actors with hidden agendas. This scepticism was particularly potent in a region with a long history of exploitation and where trust in authorities had already eroded due to chronic instability and conflict. Bienfait Wanzire, another survivor from the 2018 outbreak, recalls how election campaigns provided a narrative framework through which residents interpreted the crisis. "When a pandemic hits here in Congo, we initially think it's a political issue," he says, explaining how the overlap of disease outbreak and political activity created confusion and resistance to health interventions.
The consequences of this mistrust played out visibly in attacks on health workers and widespread refusal to engage with treatment centres. Dr Babah Mutuza Lusungu, a physician at Dieu Est Grand Medical Centre in Beni, experienced this resistance firsthand even as he lost his uncle and two colleagues to the virus. The climate of suspicion extended beyond patients to encompass the relationship between communities, authorities, healthcare providers, and international partners. When populations doubt the legitimacy of those providing care, they become reluctant to comply with isolation procedures, contact tracing, or vaccination—the very interventions most critical to breaking transmission chains. This breakdown in social cohesion transformed medical institutions from places of healing into spaces viewed with fear and hostility.
Dr Lusungu identified a critical gap in previous response efforts: the exclusion of youth from disease awareness campaigns and containment activities. Young people, he argues, were treated as passive recipients of top-down messaging rather than as active community leaders capable of influencing their peers. Had local authorities partnered with respected youth figures to educate the population from the earliest signs of an outbreak, the spread might have been curtailed before cases multiplied beyond control. "If we wait until they have so many declared cases to start making an effective response, we will have totally missed the target," he warns. This observation carries particular weight as the current outbreak accelerates, with 550 confirmed cases, 101 deaths, and only 19 recoveries recorded as of June 7.
The vaccine itself, while instrumental in halting the 2018-2020 outbreak, became a source of additional stigma and social fracture. Esperance Masinda, who contracted Ebola while caring for her infected husband during her work with the UN children's agency, witnessed how those who survived with vaccine assistance faced accusations that the medication would kill them within years. Communities ostracised survivors, treating them as harbingers of death rather than as people who had overcome the disease. The psychological toll of surviving Ebola was compounded by rejection from the very communities they sought to rejoin. "We were told that you're not going to make it even five years, you're going to die with that medication that you took there," Masinda recalls. This stigmatisation extended social suffering beyond the acute phase of infection, creating long-term isolation even for those who recovered.
What makes the current outbreak particularly concerning is that it emerged without the benefit of an approved vaccine specific to the Bundibugyo strain. The previous epidemic's vaccination campaigns, despite initial community resistance, ultimately saved countless lives and provided crucial evidence that recovery was possible. The lack of this option now means that response efforts depend entirely on early detection, rapid isolation, contact tracing, and supportive care—interventions that require extraordinary levels of community cooperation. In an environment already scarred by previous outbreak experiences and shaped by underlying suspicion of external actors, achieving the necessary coordination will be exponentially more difficult. The institutional memory of the 2018-2020 response exists among healthcare workers and surviving patients, but that knowledge has not necessarily translated into structural changes that address the root causes of community resistance.
The survivors' testimonies underscore that technical medical solutions alone cannot contain Ebola in Congo without addressing deeper issues of trust, communication, and social integration. Masinda's observation that survivors and communities have gradually moved past stigmatisation offers a glimmer of hope, yet the current outbreak is unfolding in real time, with no guarantee that the lessons of the past will be rapidly implemented. The challenge for Congolese authorities and their international partners is to employ survivors themselves as credible messengers who can speak authentically to both the reality of the threat and the possibility of recovery. Their voices carry a legitimacy that external experts cannot match, having lived through the darkness of Ebola and emerged on the other side. The window for preventing exponential growth in the current outbreak is narrowing, and the response will ultimately depend on whether policymakers can translate these hard-won lessons into immediate action that rebuilds the trust necessary for effective disease control.
