Africa, explained.
Travellers walk through the border crossing facility at the Busia One Stop Border Post (OSBP) on the Kenya-Uganda border as health authorities step up Ebola screening measures, in Busia on 12 October 2026 (Bright Emoja/AFP via Getty Images)
Kenya caught its first case after a journey from Congo through Uganda – cooperation to catch the next one is wearing thin.
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Ebola doesn’t stop at a borderEbola doesn’t stop at a border
On 2 October, a 40-year-old Kenyan who had lived in the Democratic Republic of the Congo for seven years travelled by road through Beni to Kampala (Opens in new window). He had been ill for about a month and had been treated at several Congolese health facilities. The World Health Organisation considers that he may have acquired Ebola while seeking care for another illness, and his symptoms during travel remain unclear.
On 3 October he flew to Nairobi and went through airport health screening (Opens in new window), where, Kenyan officials suggest, medication may have masked his symptoms. A relative took him straight to Nairobi Hospital, where he was isolated. Laboratories confirmed Bundibugyo virus, a species that causes Ebola disease, on 5 October, and he died that night.
Kenya’s end of this story largely worked: isolation was quick, results came back the same day, Kenya notified WHO (Opens in new window) within a day, and by 11 October 122 contacts had been identified (Opens in new window), with no further cases found.
The weaknesses lie upstream and across borders, and the way health security is now financed is making them worse.
Officials from Kenya's Ministry of Health wait for passengers at the arrival screening point at the Jomo Kenyatta International Airport in Nairobi on 7 October 2026 (Simon Maina/AFP via Getty Images)
The man was travelling out of the second-largest Ebola outbreak on record (Opens in new window), which by 10 October had produced nearly 9,000 confirmed cases and more than 4,300 deaths (Opens in new window) across seven of Congo’s 26 provinces. Five months into the response, surveillance there is still not detecting enough cases: more than two-thirds of recent deaths (Opens in new window) occurred in communities rather than treatment centres, and contact follow-up has fallen to 80%, below the 85% target.
Cases that go undetected at home become travellers who go undetected abroad, and border screening is a thin last line of defence against them. Kenya identified the patient in hospital after he had passed through the airport checkpoint. Effective surveillance depends on people being able to reach care, report illness and act on medical advice. That requires trust and practical support alongside clinical capacity.
Those factors receive too little attention in how preparedness is assessed. Drawing on evidence from 20 countries, the NUS–Lancet PRIME Commission (Opens in new window) found in its report published in September that the leading preparedness indicators, the Global Health Security Index and WHO’s Joint External Evaluation, mainly assess technical inputs such as plans, laboratories, surveillance systems and stockpiles. These measures proved poor predictors of Covid-19 outcomes and gave too little weight to income support, sick leave, trust and other factors that determined whether people could adhere to public health guidance. Policies built this way are, in the Commission’s words, “technically coherent but socially misaligned”.
Countries that report outbreaks risk border closures and economic disruption, a prospect that can make delayed reporting or limited data sharing a rational choice rather than a moral failure.
The Kenyan patient’s journey raises questions about detection and notification across borders. Before Ebola was identified, he passed through several Congolese health facilities, a land border into Uganda and an international airport. At each of those points, detection depends on more than the equipment and training that the indices count. It also depends on whether an overstretched clinician suspects Ebola and can test for it, whether a sick person can afford to stop and seek care, and whether what one country knows reaches the next.
That last condition depends on trust between governments. The Commission found that countries that report outbreaks risk border closures and economic disruption, a prospect that can make delayed reporting or limited data sharing a rational choice rather than a moral failure. This outbreak has produced exactly those penalties: in May, governments including Canada, Jordan, Bahrain and the United States imposed entry restrictions (Opens in new window) of the kind WHO advises against. Surveillance is an interdependent function, and national systems become more effective when countries trust each other enough to share what they find.
Financing makes that cooperation harder.
First, there is far less of it than the system needs: development assistance for health fell an estimated 21% in 2025 (Opens in new window), to its lowest level in 15 years (Opens in new window), and in July the WHO–Africa CDC plan for this outbreak was more than US$400 million short (Opens in new window) of funding.
Second, what financing remains is more national in focus and bilateral in form (Opens in new window). Country-based agreements leave gaps in resourcing for joint investigation, information sharing and coordination between countries, and for the support people need to report illness and isolate. Global mechanisms must cover these costs when they fall outside individual country programs.
Shrinking aid has given African calls for health sovereignty new urgency, but there is a risk that sovereignty comes to be read as self-sufficiency. The Accra Reset, an initiative on reforming global health governance led by the President of Ghana, makes this distinction in its high-level panel report (Opens in new window), treating cross-border health intelligence, interoperable surveillance and governed data-sharing as shared public goods, with the aim of enabling countries to take their own decisions while continuing to cooperate. Effective collaboration with neighbours is an exercise of sovereignty, not a concession of it.
The measure of what has been learned from Nairobi will not be whether the next infected traveller is caught at an airport. It will be whether a clinician in Beni can get a sample tested within hours, whether the individual or family asked to isolate can afford to do so, and whether relevant information reaches officials across the border on time.
About the author
Ebere Okereke
Dr Ebere Okereke is a global health physician, an Associate Fellow in the Global Health Program at Chatham House and an Honorary Affiliate of the National University of Singapore’s Saw Swee Hock School of Public Health. She is a member of the NUS–Lancet PRIME Commission on Pandemic Readiness, whose report is discussed in this article.
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