1 Introduction

Uganda has once again faced the challenge of an Ebola outbreak, with the Ministry of Health notifying the WHO of a Sudan Ebola virus disease (SUDV) outbreak in Kampala on January 30, 2025. The outbreak began with a 32-year-old male nurse who experienced initial symptoms, including fever, on January 19, 2025. Over the following days, he sought medical care at three different health facilities, traveling across Kampala, Wakiso, and Mbale District. He also sought help from a traditional healer. Unfortunately, after battling the illness for 10 days, he was pronounced dead on January 29, 2025, at Mulago National Referral Hospital [1]. Postmortem samples were collected immediately, and RT-PCR analysis was conducted by three separate laboratories, including the Uganda Virus Research Institute, the Central Public Health Laboratories, and Makerere University, confirming the presence of Sudan ebolavirus [1, 2].

This marks the first Ebola outbreak in an urban area in Uganda and the eighth since 2000 [Table 1]. The outbreak, which began in Kampala, has now spread to Wakiso and Mbale District—areas visited by the index case [2]. The Ministry of Health confirmed that as of February 12, 2025, nine cases had been reported. The index case, who passed away last month, was the first casualty, while the other eight patients are in stable condition and undergoing treatment. Additionally, 265 contacts have been traced and quarantined [3] which underscores the critical role of strong primary healthcare systems in managing such outbreaks.

The ongoing Ebola outbreak has emerged 2 years after a previous Sudan virus disease (SUD) outbreak was identified in Uganda on September 20, 2022, following a confirmed case in Mubende District. The previous outbreak recorded 164 cases, with 55 confirmed fatalities and 87 patients recovering [4]. Uganda has battled several Ebola outbreaks over the years, beginning with the largest in 2000, which impacted Gulu, Masindi, and Mbarara, resulting in 425 cases and 224 deaths. Additional outbreaks followed in Bundibugyo (2007), Luweero (2011), Kibaale (2012), another in Luweero the same year, and Kasese (2019) [5, 6]. The country has been able to control every Ebola outbreak it has faced, employing effective strategies to halt the progression of the diseases [7]. This article analyzes the factors contributing factors to the recent Ebola resurgence in Uganda, assess the effectiveness of the response strategies employed, and provide recommendations for improving future preparedness and response efforts.

2 Factors Contributing to the Resurgence

Several interconnected factors have likely contributed to the recent Ebola resurgence in Uganda. Firstly, the Sudan virus strain presents unique challenges. While a licensed vaccine exists for the Zaire ebolavirus, the Sudan strain has historically lacked such a readily available preventative measure, complicating prevention and control efforts [7]. Research into Sudan virus vaccines is ongoing, but their widespread availability and deployment remain a challenge. Secondly, gaps in surveillance, diagnostics, and response capacity play a significant role. Delays in recognizing the index case and confirming the diagnosis underscore the persistent need for improved surveillance systems and rapid diagnostic tools [8]. Limited resources, including insufficient isolation facilities and personal protective equipment (PPE), can hinder effective case management and infection control, as highlighted by the 2022 outbreak [9].

Beyond the immediate factors related to disease spread, the root causes of zoonotic spillover events are critical to consider. Human encroachment on wildlife habitats, driven by agricultural expansion, deforestation, and infrastructure development, increases the interface between human populations and potential animal reservoirs of the virus [cite relevant sources]. Economically motivated hunting and the bushmeat trade can also facilitate the transmission of zoonotic diseases, including Ebola, from infected animals to humans [9, 10]. Understanding and addressing these underlying ecological and socioeconomic drivers is crucial for preventing future outbreaks.

Thirdly, socio-cultural factors, including cultural practices related to burial rituals and traditional healing, can influence transmission dynamics [10]. Misinformation and distrust in healthcare systems also impede public health efforts. Mobility patterns, particularly in urban areas, further accelerate the spread of the virus [11]. Finally, the government's response, while generally considered effective in past outbreaks, faces ongoing challenges. Funding gaps can limit resource allocation for preparedness and response activities. Coordination challenges among different stakeholders, including government agencies, international organizations, and local communities, can also hamper effective outbreak management [12]. A comprehensive understanding of these interacting factors is essential for developing targeted and effective interventions.

3 Impact on Public Health

The Ebola resurgence has a profound impact on Uganda's public health system and beyond, mirroring the strain experienced by healthcare systems in other African nations during similar outbreaks. Hospitals become overwhelmed with Ebola patients, stretching already limited resources and compromising the quality of care for other health conditions [12]. This strain can lead to increased morbidity and mortality from both Ebola and other treatable illnesses. For instance, during the West Africa Ebola epidemic (2014–2016), the focus on Ebola response led to disruptions in routine healthcare services, resulting in increased deaths from preventable diseases like malaria and measles [cite relevant sources]. Healthcare worker safety remains a major concern, as they are at increased risk of infection due to their close contact with patients [13]. The 2022 outbreak highlighted the high infection rates among healthcare workers, emphasizing the need for adequate PPE, training on infection prevention and control (IPC) protocols, and robust support systems for healthcare professionals, including mental health support [14]. Similar challenges were faced by healthcare workers in Sierra Leone and Liberia, underscoring the universal risks to this critical workforce during Ebola outbreaks [13, 14].

Beyond the immediate health impacts, Ebola outbreaks have significant socioeconomic consequences. Trade and travel restrictions disrupt economic activities and can lead to food insecurity [15]. School closures, implemented to prevent transmission, can negatively impact education, particularly for vulnerable populations, increasing the risk of dropout, early marriage, and child labor [16]. The long-term socioeconomic recovery in affected regions of West Africa was significantly hampered by these disruptions [9, 10]. The stigma associated with Ebola can further isolate affected communities and hinder recovery efforts, impacting social cohesion and mental well-being. Addressing stigma, as was crucial in the aftermath of outbreaks in the Democratic Republic of Congo (DRC), requires targeted community engagement and psychosocial support [16, 17]. The potential for cross-border spread is a major concern, given Uganda's porous borders and regional interconnectedness [17], a risk that necessitates strong regional collaboration, as demonstrated by the coordinated efforts during previous outbreaks in the Great Lakes region [15].

4 Response Strategies

Uganda's response strategy typically involves a multi-pronged approach, including early case detection and isolation, contact tracing, and community engagement. The establishment of Emergency Operation Centers (EOCs) facilitates coordination among different stakeholders. Mobile laboratories enable rapid diagnostic testing, crucial for timely intervention. Regional collaboration, through organizations like the East African Community (EAC) and the Africa CDC, is essential for coordinating cross-border surveillance and response efforts. Over time, Uganda has refined its Ebola response strategies, building on lessons learned from each previous outbreak [18, 19]. For example, the early establishment of strong surveillance systems and community engagement protocols evolved significantly after the initial large outbreak in 2000.

The COVID-19 pandemic also appears to have contributed to an enhanced response capacity during the 2022 SUDV outbreak. The infrastructure and technical skills developed during the COVID-19 response, such as strengthened laboratory networks for PCR testing, improved contact tracing mechanisms utilizing digital tools, and enhanced risk communication strategies, likely provided a valuable foundation for the rapid deployment of resources and implementation of control measures during the Ebola outbreak. This highlights the synergistic benefits of investing in pandemic preparedness for a range of infectious disease threats. Past outbreaks have demonstrated the importance of leveraging lessons learned and adapting strategies to the specific context of each outbreak [18, 19].

The WHO plays a critical role in coordinating the international response to Ebola outbreaks. This includes providing technical guidance, deploying experts, and mobilizing financial and logistical resources. The WHO also facilitates the development and deployment of vaccines and treatments. The Centers for Disease Control and Prevention (CDC) provides technical assistance to affected countries, including support for laboratory capacity building, epidemiological surveillance, and infection control measures. Humanitarian organizations, such as Médecins Sans Frontières (MSF), provide essential medical care, logistical support, and community outreach [20]. Community engagement is a cornerstone of effective Ebola response. Building trust with communities, addressing misinformation, and promoting culturally appropriate communication strategies are essential for ensuring public cooperation. Engaging local leaders, utilizing radio broadcasts, and employing other culturally relevant communication channels can help disseminate accurate information and promote behavior change. Addressing stigma and providing psychosocial support to affected communities are also crucial components of a comprehensive response [20, 21].

5 Lessons Learned and Future Direction

Several key lessons have emerged from past Ebola outbreaks, informing strategies for strengthening future preparedness. Investing in robust health systems is paramount. This includes strengthening surveillance systems with real-time data collection and analysis, improving diagnostic capacity at regional and local levels, ensuring adequate and readily available PPE supplies, training a surge workforce of healthcare workers on IPC protocols and clinical management, and establishing well-equipped isolation facilities with appropriate patient flow and waste management systems. Prioritizing research and development of vaccines and treatments for all Ebolavirus species is crucial, including streamlining clinical trial processes and regulatory pathways. Sustained funding for preparedness activities, moving beyond reactive emergency funding, is essential for ensuring long-term capacity building.

Strengthening health systems requires a multi-faceted approach that increasingly integrates preparedness for outbreak-prone pathogens like SUDV into existing programmatic efforts and general health system planning. For example, infection prevention and control training, initially focused on Ebola, can be integrated into the routine training of all healthcare workers and across all levels of care. Similarly, surveillance systems can be designed to be syndromic, allowing for the early detection of a range of unusual disease patterns, rather than focusing solely on specific pathogens. Investing in primary healthcare infrastructure and workforce development not only improves routine healthcare delivery but also strengthens the frontline response during outbreaks. For instance, community health workers, who are integral to primary care, can be trained in early detection, risk communication, and contact tracing. Strategic vaccine deployment plans, including pre-positioning of investigational vaccines where feasible and establishing rapid deployment mechanisms, are essential for ensuring timely and equitable access to vaccines during outbreaks. Furthermore, fostering strong community engagement mechanisms as a routine part of health programs builds trust and facilitates rapid mobilization during health emergencies.

6 Conclusion

The recent Ebola resurgence in Uganda, caused by the Sudan virus, serves as a stark reminder of the ongoing and evolving threat posed by emerging infectious diseases. While Uganda has made significant strides in managing Ebola outbreaks, the recent resurgence highlights the continuous need for improvement and adaptation of preparedness and response strategies. Addressing the multifaceted factors contributing to these outbreaks requires a comprehensive and collaborative approach that extends from local communities to the global health security architecture. Investing in resilient and integrated health systems, prioritizing sustained research and development for diagnostics, therapeutics, and vaccines for all Ebolavirus species, strengthening regional collaboration for cross-border health security, and fostering proactive and trust-based community engagement are essential for mitigating the impact of future outbreaks. By diligently learning from past experiences, adapting evidence-based strategies, and proactively integrating preparedness into broader health systems, Uganda and the international community can better prepare for and respond to future public health threats, safeguarding global health security.

Author Contributions

Majani Edward: conceptualization, writing – original draft, writing – review and editing, formal analysis, supervision. Sylivester Muhigi: writing – original draft. Joan Mundua: conceptualization, writing – original draft. Ally Ally: writing – original draft.

Ethics Statement

With respect to this type of article, we didn't seek informed consent; we used existing data from the prior findings.

Consent

Data was collected from the prior findings so no any informed consent was employed.

Conflicts of Interest

The authors declare no conflicts of interest.

Transparency Statement

The lead author Majani Edward affirms that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.