This is an unedited manuscript accepted for publication and provided as an Article in Press for early access at the author’s request. The article will undergo copyediting, typesetting, and galley proof review before final publication. Please be aware that errors may be identified during production that could affect the content. All legal disclaimers of the journal apply.
Eric Kwasi Elliason,
Arti Thakur *,
- Assistant Professor, Deparment of Public Health, Faculty of Public Health and Allied Sciences, Desh Bhagat University, Mandi Gobindgarh,, Punjab, India
- Administrative In-charge, Faculty of Allied and Healthcare Sciences, Desh Bhagat University, Punjab, India
Abstract
Background: The rapid surge in the Ebola Virus Disease (EVD) seems to have overwhelmed a seemingly resilient healthcare system, especially in countries that have recorded high numbers of infections in recent times. There is no doubt that there have been advances in diagnostics, improved vaccines, therapeutics, and better outbreak response, yet recurrent outbreaks of the virus persist. What could be wrong? With this pattern, it will not be far- fetched to suggest that important structural and systemic gaps and drivers of Ebola transmission remain unresolved. Objective: This review is motivated by our quest to answer three questions related to the Ebola outbreak. First, why does Ebola keep coming? Second, what are we missing in our prevention efforts? Third, can we build a more resilient framework for Ebola preparedness? Methods: The nature of this review demanded a robust and systematic approach. We envisaged that adoption of an integrated review framework could fulfil our aspirations. We therefore adopted an integrated review framework to help us answer our basic review queries as outlined in the objectives. The conclusions were not drawn out of a vacuum. We derived evidence from major and credible scientific databases and international public health organisations. The findings were synthesized according to major themes relevant to the review. Results: Interesting results emerged from our review. We found that interconnected factors drive persistent and recurrent Ebola outbreaks. Some of these identified factors are zoonotic spillover, weak surveillance systems in vulnerable countries, weak health systems, ecological disruption, community mistrust, misinformation, and many others. To answer how we can be prepared to fight Ebola or prevent future occurrences, we examined the potential of artificial intelligence, digital health technologies, genomic surveillance, community-based surveillance, and One Health approaches. These have the potential to strengthen preparedness and response. Conclusions: We conclude that Ebola prevention requires a drastic shift from the current reactive outbreak response to proactive preparedness response. There is a need to strengthen surveillance systems across nations. We also need to improve our health system resilience, community engagement, and regional coordination to reduce future outbreak risks. Our proposed Integrated Ebola Preparedness and Resilience Framework provides a practical systems-based approach for advancing long-term Ebola prevention and improving global health security.
Keywords: Ebola virus disease; outbreak preparedness; One Health; health systems resilience; zoonotic spillover; infectious disease surveillance
References
1. Feldmann H, Geisbert TW. Ebola haemorrhagic fever. The Lancet. 2011 Mar 5;377(9768):849-62. 2. Matangi B, Matondo P, Kayembe B, Okolo A, Tawaba D, Kinuka A, Mangala D, Odio O, Mayasi N, Lukiana T, Mandina M. Acceptability of the Ebola vaccine in the sub-Saharan African population: A systematic review and meta-analysis. BMC Infectious Diseases. 2026 Feb 6;26(1):521. 3. Kuhn JH, Adachi T, Adhikari NK, Arribas JR, Bah IE, Bausch DG, Bhadelia N, Borchert M, Brantsæter AB, Brett-Major DM, Burgess TH. New filovirus disease classification and nomenclature. Nature Reviews Microbiology. 2019 May;17(5):261-3 4. WHO Ebola Response Team. Ebola virus disease in West Africa—the first 9 months of the epidemic and forward projections. New England Journal of Medicine. 2014 Oct 16;371(16):1481-95. 6. Moon S, Sridhar D, Pate MA, Jha AK, Clinton C, Delaunay S, Edwin V, Fallah M, Fidler DP, Garrett L, Goosby E. Will Ebola change the game? Ten essential reforms before the next pandemic. The report of the Harvard-LSHTM Independent Panel on the Global Response to Ebola. The Lancet. 2015 Nov 28;386(10009):2204-21. 7. Omoleke SA, Mohammed I, Saidu Y. Ebola viral disease in West Africa: a threat to global health, economy and political stability. Journal of public health in Africa. 2016 Aug 17;7(1):534. 8. James PB, Wardle J, Steel A, Adams J. Post‐Ebola psychosocial experiences and coping mechanisms among Ebola survivors: a systematic review. Tropical Medicine & International Health. 2019 Jun;24(6):671-91. 9. Mulangu S, Dodd LE, Davey Jr RT, Tshiani Mbaya O, Proschan M, Mukadi D, Lusakibanza Manzo M, Nzolo D, Tshomba Oloma A, Ibanda A, Ali R. A randomized, controlled trial of Ebola virus disease therapeutics. New England journal of medicine. 2019 Dec 12;381(24):2293-303. 10. Piot P, Soka MJ, Spencer J. Emergent threats: lessons learnt from Ebola. International health. 2019 Sep 2;11(5):334-7. 11. Rulli MC, Santini M, Hayman DT, D’Odorico P. The nexus between forest fragmentation in Africa and Ebola virus disease outbreaks. Scientific reports. 2017 Feb 14;7(1):41613. 12. Carlson CJ, Albery GF, Merow C, Trisos CH, Zipfel CM, Eskew EA, Olival KJ, Ross N, Bansal S. Climate change increases cross-species viral transmission risk. Nature. 2022 Jul 21;607(7919):555-62. 13. Bausch DG, Schwarz L. Outbreak of Ebola virus disease in Guinea: where ecology meets economy. PLoS neglected tropical diseases. 2014 Jul 31;8(7):e3056. 14. Wilkinson A, Fairhead J. Comparison of social resistance to Ebola response in Sierra Leone and Guinea suggests explanations lie in political configurations not culture. Critical Public Health. 2017 Jan 1;27(1):14-27. 15. Snyder H. Literature review as a research methodology: An overview and guidelines. Journal of business research. 2019 Nov 1;104:333-9. 16. Breman JG, Piot P, Johnson KM, White MK, Mbuyi M, Sureau P, Heymann DL, Van Nieuwenhove S, McCormick JB, Ruppol JP, Kintoki V. The epidemiology of Ebola hemorrhagic fever in Zaire, 1976. Ebola virus haemorrhagic fever. 1978 Jan 29;103:124. 17. Baron RC, McCormick JB, Zubeir OA. Ebola virus disease in southern Sudan: hospital dissemination and intrafamilial spread. Bulletin of the World Health Organization. 1983;61(6):997. 18. Muyembe-Tamfum JJ, Kipasa M, Kiyungu C, Colebunders R. Ebola outbreak in Kikwit, Democratic Republic of the Congo: discovery and control measures. The Journal of infectious diseases. 1999 Feb 1;179(Supplement_1):S259-62. 19. Piot P. Ebola’s perfect storm. Science. 2014 Sep 12;345(6202):1221-. 20. Baseler L, Chertow DS, Johnson KM, Feldmann H, Morens DM. The pathogenesis of Ebola virus disease. Annual Review of Pathology: Mechanisms of Disease. 2017 Jan 24;12:387-418. 21. Kuhn JH, Becker S, Ebihara H, Geisbert TW, Johnson KM, Kawaoka Y, Lipkin WI, Negredo AI, Netesov SV, Nichol ST, Palacios G. Proposal for a revised taxonomy of the family Filoviridae: classification, names of taxa and viruses, and virus abbreviations. Archives of virology. 2010 Dec;155(12):2083-103. 22. Geisbert TW, Hensley LE. Ebola virus: new insights into disease aetiopathology and possible therapeutic interventions. Expert reviews in molecular medicine. 2004 Sep;6(20):1-24. 23. Leroy EM, Kumulungui B, Pourrut X, Rouquet P, Hassanin A, Yaba P, Délicat A, Paweska JT, Gonzalez JP, Swanepoel R. Fruit bats as reservoirs of Ebola virus. Nature. 2005 Dec 1;438(7068):575-6. 24. Olivero J, Fa JE, Real R, Márquez AL, Farfán MA, Vargas JM, Gaveau D, Salim MA, Park D, Suter J, King S. Recent loss of closed forests is associated with Ebola virus disease outbreaks. Scientific reports. 2017 Oct 30;7(1):14291. 25. Pigott DM, Golding N, Mylne A, Huang Z, Henry AJ, Weiss DJ, Brady OJ, Kraemer MU, Smith DL, Moyes CL, Bhatt S. Mapping the zoonotic niche of Ebola virus disease in Africa. elife. 2014 Sep 8;3:e04395. 26. Jones KE, Patel NG, Levy MA, Storeygard A, Balk D, Gittleman JL, Daszak P. Global trends in emerging infectious diseases. Nature. 2008 Feb 21;451(7181):990-3. 27. Amimo F, Lambert B, Magit A. What does the COVID-19 pandemic mean for HIV, tuberculosis, and malaria control?. Tropical medicine and health. 2020 May 13;48(1):32. 28. Heymann DL, Weisfeld JS, Webb PA, Johnson KM, Cairns T, Berquist H. Ebola hemorrhagic fever: Tandala, Zaire, 1977–1978. Journal of Infectious Diseases. 1980 Sep 1;142(3):372-6. 29. Towner JS, Sealy TK, Khristova ML, Albariño CG, Conlan S, Reeder SA, Quan PL, Lipkin WI, Downing R, Tappero JW, Okware S. Newly discovered ebola virus associated with hemorrhagic fever outbreak in Uganda. PLoS pathogens. 2008 Nov 21;4(11):e1000212. 30. Frieden TR, Damon I, Bell BP, Kenyon T, Nichol S. Ebola 2014—new challenges, new global response and responsibility. New England Journal of Medicine. 2014 Sep 25;371(13):1177-80. 31. Gostin LO, Lucey D, Phelan A. The Ebola epidemic: a global health emergency. Jama. 2014 Sep 17;312(11):1095-6. 32. Wells CR, Pandey A, Ndeffo Mbah ML, Gaüzère BA, Malvy D, Singer BH, Galvani AP. The exacerbation of Ebola outbreaks by conflict in the Democratic Republic of the Congo. Proceedings of the National Academy of Sciences. 2019 Nov 26;116(48):24366-72. 33. Parpia AS, Ndeffo-Mbah ML, Wenzel NS, Galvani AP. Effects of response to 2014–2015 Ebola outbreak on deaths from malaria, HIV/AIDS, and tuberculosis, West Africa. Emerging infectious diseases. 2016 Mar;22(3):433. 34. Delamou A, El Ayadi AM, Sidibe S, Delvaux T, Camara BS, Sandouno SD, Beavogui AH, Rutherford GW, Okumura J, Zhang WH, De Brouwere V. Effect of Ebola virus disease on maternal and child health services in Guinea: a retrospective observational cohort study. The Lancet Global Health. 2017 Apr 1;5(4):e448-57. 35. Shultz JM, Cooper JL, Baingana F, Oquendo MA, Espinel Z, Althouse BM, Marcelin LH, Towers S, Espinola M, McCoy CB, Mazurik L. The role of fear-related behaviors in the 2013–2016 West Africa Ebola virus disease outbreak. Current psychiatry reports. 2016 Nov;18(11):104. 36. Huber C, Finelli L, Stevens W. The economic and social burden of the 2014 Ebola outbreak in West Africa. The Journal of infectious diseases. 2018 Nov 22;218(Supplement_5):S698-704. 37. Smith WC. Consequences of school closure on access to education: Lessons from the 2013–2016 Ebola pandemic. International Review of Education. 2021 Apr;67(1):53-78. 38. Vinck P, Pham PN, Bindu KK, Bedford J, Nilles EJ. Institutional trust and misinformation in the response to the 2018–19 Ebola outbreak in North Kivu, DR Congo: a population-based survey. The Lancet Infectious Diseases. 2019 May 1;19(5):529-36. 39. Jacob ST, Crozier I, Fischer WA, Hewlett A, Kraft CS, Vega MA, Soka MJ, Wahl V, Griffiths A, Bollinger L, Kuhn JH. Ebola virus disease. Nature reviews Disease primers. 2020 Feb 20;6(1):13. 40. Bell BP. Overview, control strategies, and lessons learned in the CDC response to the 2014–2016 Ebola epidemic. MMWR supplements. 2016;65. 41. Kieny MP, Evans DB, Schmets G, Kadandale S. Health-system resilience: reflections on the Ebola crisis in western Africa. Bulletin of the World Health Organization. 2014;92:850-. 42. World Health Organization. Managing epidemics: key facts about major deadly diseases. World Health Organization; 2018. 43. Vetter P, Fischer WA, Schibler M, Jacobs M, Bausch DG, Kaiser L. Ebola virus shedding and transmission: review of current evidence. The Journal of infectious diseases. 2016 Oct 15;214(suppl_3):S177-84. 44. Dowell SF, Mukunu R, Ksiazek TG, Khan AS, Rollin PE, Peters CJ. Transmission of Ebola hemorrhagic fever: a study of risk factors in family members, Kikwit, Democratic Republic of the Congo, 1995. The Journal of infectious diseases. 1999 Feb 1;179(Supplement_1):S87-91. 45. Nkengasong JN, Tessema SK. Africa needs a new public health order to tackle infectious disease threats. Cell. 2020 Oct 15;183(2):296-300. 46. Fall IS, Rajatonirina S, Yahaya AA, Zabulon Y, Nsubuga P, Nanyunja M, Wamala J, Njuguna C, Lukoya CO, Alemu W, Kasolo FC. Integrated Disease Surveillance and Response (IDSR) strategy: current status, challenges and perspectives for the future in Africa. BMJ global health. 2019 Jul;4(4):e001427. 47. Tambo E, Ugwu EC, Ngogang JY. Need of surveillance response systems to combat Ebola outbreaks and other emerging infectious diseases in African countries. Infectious diseases of poverty. 2014 Aug 5;3(1):29. 48. World Health Organization, UNEP United Nations Environment Programme, World Organisation for Animal Health. One health joint plan of action (2022‒2026): working together for the health of humans, animals, plants and the environment. World Health Organization; 2022 Oct 14. 49. Wong ZS, Zhou J, Zhang Q. Artificial intelligence for infectious disease surveillance and outbreak prediction. Front Public Health. 2020;8:580386. 50. Destoumieux-Garzón D, Mavingui P, Boetsch G, Boissier J, Darriet F, Duboz P, Fritsch C, Giraudoux P, Le Roux F, Morand S, Paillard C. The one health concept: 10 years old and a long road ahead. Frontiers in veterinary science. 2018 Feb 12;5:14. 51. Henao-Restrepo AM, Camacho A, Longini IM, Watson CH, Edmunds WJ, Egger M, Carroll MW, Dean NE, Diatta I, Doumbia M, Draguez B. Efficacy and effectiveness of an rVSV-vectored vaccine in preventing Ebola virus disease: final results from the Guinea ring vaccination, open-label, cluster-randomised trial (Ebola Ça Suffit!). The Lancet. 2017 Feb 4;389(10068):505-18. 52. Nkengasong JN, Ndembi N, Tshangela A, Raji T. COVID-19 vaccines: how to ensure Africa has access. Nature. 2020 Oct 8;586(7828):197-9. 53. Iyamu I, Xu AXT, Gómez-Ramírez O, Ablona A, Chang HJ, Mckee G, et al. Role of digital technology in epidemic control: a scoping review on Ebola and COVID-19 outbreaks. [Journal name]. 2025 [cited 2026 May 28]. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC11759881/ 54. Kruk ME, Myers M, Varpilah ST, Dahn BT. What is a resilient health system? Lessons from Ebola. The Lancet. 2015 May 9;385(9980):1910-2. 55. Mas-Coma S, Bargues MD. The First Global Forum of WHO Collaborating Centres and the One Health Summit, a landmark event redefining the future of global health science, with a reviewed history and update of the One Health concept. One Health. 2026 May 9:101441. 56. Amukele TK, Sokoll LJ, Pepper D, Howard DP, Street J. Can unmanned aerial systems (drones) be used for the routine transport of chemistry, hematology, and coagulation laboratory specimens?. PloS one. 2015 Jul 29;10(7):e0134020. 57. Quick J, Loman NJ, Duraffour S, Simpson JT, Severi E, Cowley L, Bore JA, Koundouno R, Dudas G, Mikhail A, Ouédraogo N. Real-time, portable genome sequencing for Ebola surveillance. Nature. 2016 Feb 11;530(7589):228-32. 58. Tessema SK, Inzaule SC, Christoffels A, Kebede Y, de Oliveira T, Ouma AE, Happi CT, Nkengasong JN. Accelerating genomics-based surveillance for COVID-19 response in Africa. The Lancet Microbe. 2020 Oct 1;1(6):e227-8. 59. Gire SK, Goba A, Andersen KG, Sealfon RS, Park DJ, Kanneh L, Jalloh S, Momoh M, Fullah M, Dudas G, Wohl S. Genomic surveillance elucidates Ebola virus origin and transmission during the 2014 outbreak. science. 2014 Sep 12;345(6202):1369-72. 60. Diallo B, Sissoko D, Loman NJ, Bah HA, Bah H, Worrell MC, Conde LS, Sacko R, Mesfin S, Loua A, Kalonda JK. Resurgence of Ebola virus disease in Guinea linked to a survivor with virus persistence in seminal fluid for more than 500 days. Clinical infectious diseases. 2016 Nov 15;63(10):1353-6.
International Journal of Tropical Medicines
| Volume | 03 | |
| 02 | ||
| Received | 27/10/2026 | |
| Accepted | 31/10/2026 | |
| Published | 11/11/2026 | |
| Publication Time | 15 Days |