Why are we always so unprepared?

The outbreak of Ebola Bundibugyo virus has once again exposed the cycle of securitisation and neglect in our response to emerging and re-emerging infectious diseases.

The World Health Organization’s declaration on Sunday of a public health emergency of international concern for the Ebola Bundibugyo virus raises an uncomfortable question that extends far beyond the forests of eastern Congo: why are we unprepared for viral threats that we have known about and studied for decades?

The answer, evident across a pattern of recent outbreaks from mpox to Marburg to Andes hantavirus, reveals a fundamental paradox in how the international health community manages on-going threats posed by emerging infectious diseases (EIDs).

On one hand, we have what might be termed the securitisation of EIDs – viruses that threaten the security of the global order initially galvanise health bureaucracies to action, commanding political attention and attracting research funding. On the other hand, once the acute phase of the crisis has passed, these same EIDs tend to slip down the political agenda and fall into institutional neglect.

Between this securitisation and neglect lies a vast gap where preparedness should lie but is rarely found.

Bundibugyo first emerged as a distinct viral species in 2007 when it sparked an outbreak in south-western Uganda, causing 131 cases and 42 deaths. In response, international health teams were deployed to the site of the outbreak to collect samples and study the virus. Then something curious happened: the world largely forgot about it.

For the next eighteen years, Bundibugyo languished on the margins of global health. There was no vaccine development programme. No governments prepared medical countermeasures. No coordinated surveillance system watched and waited for its re-emergence.

By contrast, after the 2014-2016 West African Ebola epidemic killed over 11,000 people, resources flowed to the region and vaccines for Zaire ebolavirus were developed at unprecedented speed. Monoclonal antibody treatments were created. Countries built the infrastructure to respond. But Bundibugyo? It seemed manageable, containable – a medical curiosity and artefact of the past.

Then in 2025, the virus re-emerged in Ituri Province in the eastern Democratic Republic of the Congo (DRC) and health responders discovered the medical arsenal was empty. “Unlike other Ebola strains, there are currently no approved Bundibugyo-specific therapeutics or vaccines,” the WHO noted in its emergency declaration on May 17.

By then, cases had been circulating for months undetected or unconfirmed in the region. A Congolese man died in Kampala, Uganda’s capital, before the outbreak was officially recognized. Across the DRC and Uganda, there were reports of over 80 suspected deaths. The real numbers were almost certainly higher but because of the absence of rapid diagnostics, the WHO acknowledged there were “significant uncertainties” about the precise number of people infected and the extent of the virus’s “geographic spread”. In a war-torn region of Africa with high population mobility that is something that should concern us all.

This pattern of delayed response and institutional unpreparedness has become familiar across multiple EID threats. The same cyclical failure – securitisation followed by neglect — has characterised responses to other recent viral outbreaks, exposing a global health system organised around panic rather than along rational scientific lines.