Comparing U.S. Ebola Outbreak Response Capabilities and Practices Over Time

The current Ebola outbreak centered in the Democratic Republic of the Congo (DRC), first identified in May 2026, has rapidly developed into the third largest Ebola outbreak on record. It presents particular challenges for responders because there are no readily available vaccines or treatments for the species of Ebola causing this outbreak, which is also taking place in a region with active conflict and multiple concurrent humanitarian crises. It is also the most significant international infectious disease outbreak the Trump administration has had to face in its second term. Given major changes made by the administration to U.S. global health and pandemic response mechanisms over the past year and half – including reducing funding, cutting staff, changing priorities and shuttering USAID – some have raised concerns that U.S. international disease response capacity has been compromised and the effectiveness of the U.S. response has been limited. Others have observed that the U.S. has, in comparison to previous Ebola responses, mobilized relatively quickly this time. To help put U.S. capacities and actions in further context, this analysis compares the current U.S. Ebola response to those of the two prior largest outbreaks – the West African outbreak of 2014-2015 and the DRC outbreak of 2018-2020¹ looking across a range of indicators and categories. Even so, such comparisons are complex, as there are many interrelated factors that affect any governmental response — including the severity and size of the outbreak itself, the response of other international and domestic actors, whether there are medical countermeasures available, and whether the outbreak is occurring under exceptionally difficult conditions, such as active conflict.

Taking these dimensions into consideration, this analysis finds that:

• The speed of the U.S. government’s response to the current outbreak is on par with the prior two outbreaks. In all three cases, the U.S. mobilized an initial response, including funding and personnel, within days of cases first being reported.
• Initial U.S. funding amounts are already surpassing the prior two outbreaks. The U.S. provided $21 million in the first six months of the West African outbreak, $98 million in the first year of the 2018-2020 DRC outbreak and has already pledged $375 million in the first two months of the current outbreak.  Given that it is still relatively early in the current outbreak, which could become protracted, final U.S. funding levels will likely grow; the administration has already asked Congress for emergency funding of $1.4 billion. 
• Across all outbreak responses including the current response, the U.S. has consistently supported research and development (R&D) for Ebola countermeasures such as diagnostics, tests, treatments, and vaccines, which has been instrumental in identifying and testing new vaccine and treatment candidates; given that there is no vaccine or specific treatments for the current species of Ebola, this work is quite critical.
• At the same time, a significant difference between current and past responses is in the U.S. organizational structure and approach, resulting from the changes made last year by the administration. Past responses were led by USAID and its Office of Foreign Disaster Assistance (OFDA), with a major role played by CDC. Given the dissolution of USAID in 2025, the response lead has shifted to the State Department and its Bureau of Global Health Security and Diplomacy (GHSD) and Bureau of Disaster and Humanitarian Response (DHR), both of which have seen their staffing reduced over the past year. Past responses also had White House National Security Council (NSC) level offices and staff with specific responsibilities for international infectious disease response coordination, something initially absent this time. The current relative lack of specified inter-departmental coordination mechanisms could affect the U.S. response over time, particularly if the outbreak is protracted and the U.S. response scales up further, although there are indications that the administration may seek to name an Ebola response coordinator.
• In addition, while the U.S. has had pre-existing global health programs in these countries when each outbreak has occurred, the current U.S. response takes place after significant upheaval in U.S. global health programs, and as the administration implements its new America First Global Health Strategy, including through a new memorandum of understanding (MOU) the U.S. signed with the DRC in February, three months before the current outbreak was identified. That new agreement will reduce U.S. funding over time and shift financial and operational responsibility to the country.  
• Another notable difference is in U.S. multilateral engagement. In the past, the U.S. was directly engaged with the World Health Organization (WHO) and synced to the strategic pillars identified by WHO and other partners in Ebola response plans. Having left WHO membership last year, the U.S. is, for the first time, not formally coordinating with the agency, although it is coordinating with other United Nations (UN) agencies including the Office for the Coordination of Humanitarian Affairs (OCHA), the International Organization for Migration (IOM), the World Food Programme (WFP), and the United Nations Children’s Fund (UNICEF). The lack of formal relations with WHO, however, could have implications as the response continues to unfold, and present barriers to communications or coordination at times.
• There is also a marked difference in how the U.S. has approached domestic border protection in the current outbreak compared to the past. During prior outbreaks, the U.S. relied on country exit screening, screening at U.S. ports of entry, and follow-up monitoring of travelers from affected countries but not outright travel bans. At present, the administration has imposed a more restrictive posture barring incoming travelers altogether (U.S. citizens and non-citizens that have been in DRC within the last 21 days, as well as non-citizens that have been in Uganda or South Sudan in that time period).  

While it is still early to take full stock of the U.S. response to the current outbreaks, based on this analysis some key questions and areas to watch going forward include:

• Will this escalate and potentially require more long-standing U.S. engagement?
• Will the level of U.S. international engagement shift, particularly if the outbreak worsens significantly and/or spreads beyond DRC borders in a more substantial way?
• If the outbreak does expand significantly, will the U.S. support greater mobilization of U.S. staff?
• Will Congress appropriate emergency funding?
• How might the outbreak affect other U.S. supported health efforts in the DRC including the recently signed MOU on global health?
• What will happen with the approach to U.S. border security, especially if more Americans become infected? What other domestic response would be put in place if Ebola cases are identified in the U.S.?

1. There was an earlier, smaller Ebola outbreak in 2018 in the northwestern Equateur Province in DRC, initially identified in May 2018. The Equateur outbreak was contained by the end of July 2018, just weeks before the before another, separate, and eventually much larger, outbreak was identified in the Ituri Province in eastern DRC in August 2018. This analysis does not examine the U.S. response to the Equateur outbreak. ↩︎