Uncovering the Drivers of Ebola Virus Disease Resurgence in DRC: A Root Cause Analysis of the 16th Outbreak in Mwaka, Kasai Province (2025)

Background: The Democratic Republic of the Congo (DRC) experienced its 16th Ebola Virus Disease (EVD) outbreak in 2025, centered in the Bulape Health Zone of Kasai Province. This outbreak occurred amid multiple concurrent epidemics and in a region with limited health infrastructure. Genomic sequencing revealed a new zoonotic spillover, genetically related to the 1976 Yambuku strain. Methods: A Root Cause Analysis (RCA) was conducted using the “5 Whys” framework, integrating epidemiological data, genomic analysis, and surveillance reports. Key contributing factors to delayed detection and response were identified. Comparative insights were drawn from the 2018–2020 North Kivu EVD outbreak. Results: The outbreak resulted in 28 confirmed, probable, or suspected cases and 15 deaths, including four healthcare workers. Root causes included poor ecological surveillance, weak community alert systems, diagnostic delays, health system overload from concurrent outbreaks, and structural underfunding. These factors contrast with North Kivu, where response delays were driven more by security issues. Conclusions: The 2025 Mwaka outbreak highlights how ecological and systemic vulnerabilities allow novel Ebola spillovers to escalate. Effective future preparedness will require sustained investment in One Health surveillance, decentralized diagnostics, and resilient public health governance.