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

Table 1. Comparing U.S. Responses to Three Ebola Outbreaks 2014-2015 West Africa
Ebola Outbreak 2018-2020 DRC
Ebola Outbreak 2026 DRC
Ebola Outbreak Key Outbreak Characteristics Date of initial case report/confirmation March 21, 2014
(First lab confirmed cases from Guinea) August 1, 2018
(Outbreak declared by Democratic Republic of the Congo (DRC) Ministry of Health (MOH)

August 7 (lab confirmed cases reported).

May 5, 2026(DRC notified World Health Organization (WHO) of possible outbreak) 

May 15, 2026 (lab confirmed cases reported)

Date of first WHO Emergency Committee (EC) Meeting to Assess This Outbreak August 7, 2014 October 17, 2018 May 19, 2026 Date of Initial WHO “Public Health Emergency of International Concern (PHEIC) declaration August 8, 2014
(141 days after initial cases identified) July 17, 2019
(almost 1 year after first case reports, due to the WHO EC initial determination the outbreak was not a regional threat, a key criteria for PHEIC determinations). May 17, 2026
(16 days after first cases identified, 2 days after first cases confirmed).

PHEIC declaration was made by Director-General before Emergency Committee met.

Virus species Zaire Zaire Bundibugyo Primary countries affected Guinea, Liberia, Sierra Leone DRC DRC and Uganda Total number of reported cases and deaths 28,610 cases, 11,323 deaths over 28 months (outbreak declared over in June 2016) 3,470 cases and 2,287 deaths over 22 months (outbreak declared over in June 2020) 3,200 cases, 1405 deaths (over 8 weeks, through July 25, 2026) Vaccine availability No vaccine available initially. Clinical trials with candidate vaccines began in in West Africa in February and March 2015. A candidate vaccine was made available under a compassionate use protocol for broader community “ring vaccination” purposes in March 2016 in Guinea. Yes. Over 236,000 people vaccinated in DRC during the outbreak response. No vaccine availability at this time. Trials with candidate vaccines began in July 2026. Therapeutics availability No therapeutics available initially. Limited use of experimental therapeutics began in August 2014; clinical trials began in March 2015. Limited use of experimental therapeutics in 2018; a trial of several candidate treatments began November 2018. No therapeutics available at this time. Clinical trials of experimental candidates began in July 2026. Active conflict/ instability in affected areas No Yes Yes U.S. Funding for Response Speed of initial U.S. response funding

(time from outbreak detection to mobilization of U.S. response funds)

Initial U.S. Agency for International Development (USAID)/Office of Foreign Disaster Assistance (ODFA) funding provided in March 2014, soon after initial outbreak reports.

Centers for Disease Control and Prevention (CDC) supported initial staff deployments to affected areas in late March/early April. As the outbreak worsened considerably over subsequent months, U.S. funding scaled up, particularly from August 2014 on.

Initial USAID funding provided in August 2018, within weeks of the initial announcement of confirmed Ebola cases in eastern DRC. CDC also supported staff deployments and response activities in August. 

As outbreak worsened considerably in March/April 2019, U.S. response funding scaled up.

Initial funding announced on May 19.
(four days after initial case confirmation and two days after PHEIC declaration). Amount and source of initial response funding Between March and August 2014, $21 million in cumulative response funding reported from USAID. By October 2014, CDC had committed >$16.7 million for its Ebola response activities. Initial funding drawn from USAID International Disaster Assistance funds As of September 5, 2018, USAID had provided at least $2 million for response activities. Over the first 11 months of the response (through July 2019) USAID reported $98 million in support for the response.  Funds drawn from unspent FY2015 Ebola emergency supplemental funds. State Department announced $23 million in initial Ebola response funding on May 19, drawn from existing FY2026 State Department humanitarian assistance funds.  Total U.S. response funding amount and source Approximately $2 billion in U.S. international response funding obligated by the end of 2015, primarily through emergency/supplemental appropriations provided to USAID and CDC. From August 2018 to June 2020, USAID provided over $342 million for response activities, drawn from USAID International Disaster Assistance, USAID/Global Health, USAID/Food for Peace, and USAID Mission funds. USAID used unspent FY2015 Ebola emergency supplemental funds. $270 million was committed by the State Department as of June 12, drawn from State Department’s existing FY2026 humanitarian response funds. The U.S. has made an overall pledge of $375 million in support of the response as of June 19. Emergency / supplemental funding requests and appropriations White House requested $6.2 billion in emergency supplemental funding in November 2014. In December 2014, Congress appropriated $5.4 billion, including $3.7 for international response activities. None requested. White House requested $1.4 billion in emergency supplemental funding in June 2026. As of July 2026, Congress had not yet appropriated additional funding. U.S. funding share of overall international response funding The U.S. was the largest donor to the response, providing $2.4 billion (41%) of the $5.81 billion in overall donor funding provided between 2014 and 2016. The U.S. was the largest donor to the response, providing $252 million (34%) of the $734 million in overall donor funding provided between August 2018 and December 2019. The $375 million pledged $375 million by the US for Ebola response activities represents 41% of the $910 million in overall donor funding ‌pledges made by international donors in support of the joint continental Ebola response plan. U.S. Staff Deployments, EOC Activation Staff Mobilized/ Deployed Prior to the outbreak, USAID and CDC presence in the three most affected countries “very limited.” On March 31, 2014, a 5-person CDC team deployed to Guinea. In August 2014, 28-member DART team deployed (staff from USAID, CDC, the Department of Defense (DoD), other agencies).

By the end of the outbreak, over 3,500 personnel from DoD, CDC, U.S. Public Health Service (USPHS) Commissioned Corps, USAID, and National Institutes of Health (NIH) were deployed.

First 5 CDC staff deployed to North Kivu August 2018 (pulled back after a few days). By May 2019, CDC had 17 staff in Kinshasa and Goma. 

USAID established a DART team on September 21, 2018. 

During response, U.S. staff kept away from front lines due to security concerns.

CDC reports it has 23 field staff in DRC and over 100 staff in Uganda.

State Department has deployed an unknown number of staff from GHSD and DHR via DART to DRC and Uganda.

CDC Emergency Operations Center (EOC) Activation EOC activated on July 9, 2014. (110 days after initial case confirmations).

On March 31, 2016, CDC officially deactivated the EOC for this response.

EOC activated in June 2019. (10 months after initial case confirmations).

The EOC was deactivated some time in 2020, no official announcement made.

EOC activated on May 17, 2026 (two days after case confirmations)

Raised to “highest alert level” June 26, 2026.

U.S. Organizational Approach Agencies involved and coordination USAID/OFDA, CDC, DoD, NIH, and State Department. 

In May 2014, the White House asked the HHS Office of Global Affairs to coordinate the U.S. government response, with USAID as operational lead and CDC as lead on technical and public health issues. 

As the outbreak continued to expand in West Africa, and several Americans working in West Africa became infected with Ebola, President Obama became directly involved, offering to send U.S. troops in September, and appointing an Ebola Response Coordinator in October 2014 who eventually led coordination of U.S. agencies through a position at the National Security Council (NSC)

USAID/OFDA, CDC. 

No NSC-level leader designated for coordinating U.S. response, as the global health security team at NSC was disbanded in May 2018 during a reorganization process under the first Trump Administration. Primarily,  coordination occurred at the department/agency level.

USAID was dissolved in 2025, making the State Department the primary response agency along with CDC. At the State Department, the Bureau of Global Health Security and Diplomacy (GHSD), and Bureau of Disaster and Humanitarian Response (DHR) are the key bureaus overseeing response activities. 

No specific NSC GHS staff/office designated initially to provide coordination, though a director for bioresponse at the National Security Council was named in July. In June, Secretary of State Rubio stated the administration is considering naming an Ebola response coordinator to oversee the U.S. response.

Pre-existing U.S. Global Health Programs in Affected Countries Amount of U.S. GH funding in affected countries in the fiscal year prior to initial outbreak

(amounts are disbursements for the indicated fiscal year)

In FY2014, U.S. GH funding by affected country was:
–Guinea: $18.8 million, primarily for malaria and family planning/ reproductive health (FPRH), plus maternal and child health (MCH), and HIV/AIDS.
–Liberia: $26.2 million, primarily malaria, MCH, and FPRH, plus HIV/AIDS, and Nutrition.
–Sierra Leone: $750k for HIV/AIDS. In FY2018, U.S. GH funding for DRC was $146.4 million, primarily for malaria, HIV/AIDS, MCH, FPRH, tuberculosis (TB), Global Health Security (GHS), and Nutrition.  In FY2025, U.S. GH funding for DRC was $165.8 million, primarily for malaria, HIV/AIDS, MCH, FPRH, GHS, and Nutrition. U.S. Communications Practices USG public communications on Ebola response Regular communications from USAID, CDC and other federal agencies on international response activities, domestic public health guidance. National press conferences and televised briefings were featured. Notable White House involvement in communications starting in August 2014 due to significant public interest in the topic following identification of Ebola cases in the U.S. USAID had the lead for communications regarding U.S. response operations in West Africa, while HHS (including CDC) and the National Security Council handled communications about domestic Ebola cases. Comparatively less U.S. public attention compared to 2014. Still, CDC and USAID provided situation updates, travel notices, technical guidance. WH public facing engagement was not apparent.

 

CDC has conducted media briefings, technical briefings, publication of updates, guidance, risk assessments. State Department has provided press conferences, semi-regular posts about U.S. activities and support. President Trump mentioned U.S. support for international response in public remarks. U.S. Research & Development Support U.S. support for countermeasures R&D, including vaccines NIH provided accelerated early clinical trials of vaccine candidates, and field efficacy studies in Guinea and Liberia. U.S. supported evaluation of several experimental therapies, including ZMapp, TKM-Ebola, Favipiravir, and convalescent plasma.   NIH supported ZMapp investigational treatment R&D in DRC.The rVSV Ebola vaccine was used extensively during the response, under expanded-access, with the U.S. supporting vaccine logistics, effectiveness monitoring, operational research, ring vaccination strategy, and other related activities.   U.S. research response has focused on evaluating cross-protection of existing vaccines/treatments, development of multivalent vaccine candidates.USG committed $50 million to the Coalition for Epidemic Preparedness Innovations (CEPI) to advance Bundibugyo vaccine R&D.

BARDA/Mapp Biopharmaceutical announced a transfer of investigational doses of MBP134 monoclonal antibody to DRC. 

U.S. Multilateral Engagement U.S. multilateral engagement on response activities The U.S. led much of the response, especially in the early stages in 2018, as the WHO-led multilateral response took time to scale up. U.S. response primarily bilateral, with a focus particularly on supporting activities in Liberia 

As the multilateral response expanded, the U.S. engaged as active, partner for WHO, UN agencies, and the UN special mission for Ebola response known as UNMEER that was created in September 2014. U.S. activities and engagement spanned all major “response pillars” outlined in multilateral response plans. The U.S. was the largest donor to WHO’s Ebola response activities, providing $73.9 million, and largest donor overall to Ebola response in the region.

The U.S. played an important, though more supporting role as WHO and the DRC government primarily led the response. U.S. activities supported the Ebola response plan developed by DRC, WHO and other international partners. U.S. agencies (including NIH, USAMRIID, and CDC) as well as U.S. funded NGOs were listed as supporting partners across most of the response sectors/pillars, though the U.S. CDC was the only U.S. agency listed as a co-lead (along with WHO) for one of the main response pillars (“Health Information and Analytics”). Following U.S. withdrawal as a WHO member state, communication and engagement with WHO is limited. The U.S. has direct engagement with UN humanitarian response organizations including OCHA, WFP, UNICEF. The multisectoral continental response plan released by DRC, WHO, and Africa CDC lists the following USG entities as partners across response activities: CDC as co-lead for the surveillance and epidemiology & laboratory systems and genomic sequencing response pillars, and NIH as a partner organization for the clinical trials/R&D sub-pillar. Domestic border protection measures U.S. government border policies during Ebola response Focused on exit screening of travelers from at-risk countries, and entry risk assessment and management for incoming travelers. Travelers from West Africa were primarily directed through five US airports where they went through CDC-designed screening and follow-up with active monitoring of at-risk contacts. In limited cases, there were state-imposed quarantines/isolation. CDC implemented routine border health security measures at ports of entry. No additional measures imposed. The U.S. has barred entry for all travelers on commercial flights who were recently in DRC – including U.S. citizens – and non-U.S. citizen travelers who were recently in Uganda or South Sudan. U.S. officials have stated they do not wish to repatriate any Americans who become infected with Ebola overseas. Already, two U.S. citizen health care workers infected with Ebola in DRC have been transported to Germany for monitoring and treatment, rather than brought to the U.S., and seven American aid workers working on the Ebola response in DRC have been sent to a facility in Kenya to quarantine rather than allowed to return to the U.S. immediately.