Border screening gaps, insecurity hamper Africa's Ebola response

Gaps in border screening, inadequate quarantine facilities and insecurity in Ebola-affected areas are complicating efforts to contain the outbreak in parts of Africa, the World Health Organization or WHO has warned, as cases reported in Kenya and Nigeria highlight the challenges of detecting infections and preventing cross-border transmission.

During an online media briefing on Thursday, WHO Regional Office for Africa warned that the outbreak was becoming more complex and called for stronger regional surveillance, faster case detection and better protection for healthcare workers.

The agency cautioned that border screening alone could not identify every infected traveler, particularly those who had not developed a fever or visible symptoms or did not disclose possible exposure.

"Ebola does not wait. It follows movement, exploits gaps and tests the strength of our health systems," Mohamed Yakub Janabi, WHO regional director for Africa, said.

"Today, the test is no longer confined to one place. It is a regional concern that demands regional vigilance and collective resolve," he said, calling for early detection, contact tracing, protection of healthcare workers and stronger cross-border surveillance.

Despite a recent decline in reported cases in some affected areas, gaps in contact tracing and delays in diagnosis have raised concerns that undetected infections could fuel further transmission, reinforcing fears that the outbreak could pose a wider regional public health threat.

The warning comes as the Democratic Republic of the Congo continues to battle the outbreak despite a recent decline in reported cases.

Wessam Mankoula, head of the Continental Incident Management Support Team at the Africa Centres for Disease Control and Prevention, said more than 80 percent of cases were being detected among people not previously identified as contacts, suggesting that transmission chains remained undetected.

Africa CDC cautioned that the decline in reported Ebola cases might not be sustained due to community resistance, insecurity and operational challenges that affect contact tracing and case detection. Mankoula also highlighted deaths occurring in communities, which point to continuing difficulties in identifying infections and reaching patients early.

"These operational challenges and contact tracing do not give us confidence that this decrease is sustainable," he said, adding that more resources were being deployed to strengthen response activities.

The challenges extend beyond the DRC. Nigeria reported its first imported case of Bundibugyo Ebola on Oct 20, while Kenya recorded nine confirmed cases, including the initial imported case and eight subsequent cases. In Nigeria, Africa CDC said 44 close contacts had initially been identified, with investigations continuing to identify additional contacts and establish how the patient had been exposed.

The ongoing investigation highlights the challenges of identifying potential exposures after cross-border travel and the importance of timely reporting, information sharing and rapid contact tracing

Marie-Roseline Belizaire, director for emergency preparedness and response at the WHO Regional Office for Africa, said border screening remained important but could not detect every infected traveler. Measures at official entry points include travel declaration forms, temperature checks and visual observation by healthcare workers.

"Some of these three measures can miss a case, particularly if somebody does not declare their exposure, or if they do not have a high fever at the time they are moving, or they don't look visibly sick," she said.

Belizaire also highlighted the difficulty of monitoring movement across the long, porous border between the DRC and Uganda, where people regularly cross for healthcare and trade.

In Kenya, quarantine and infection prevention have presented additional challenges.

Patrick Amoth, director-general of the Kenya's Ministry of Health, said some facilities were not designed to maintain the infection prevention and control measures required for Ebola.

"One of the challenges that we have had to deal with is that, because we didn't have a proper isolation center, quarantine was a challenge, especially in terms of maintaining infection prevention control measures," Amoth said.

"We think there were gaps in infection prevention control when they were managing the index case," Amoth said, adding that some facilities had COVID-19 protective equipment that was unsuitable for Ebola.

Kenya has since distributed Ebola-specific personal protective equipment to healthcare workers in 12 very high-risk and 26 high-risk counties and continued training on infection prevention.

Despite the challenges, WHO urged governments and communities to remain vigilant rather than fearful, saying early action and regional cooperation were essential to stopping transmission.

"Ebola can cross borders, but we know how to stop transmission when we act early and decisively," Janabi said. "No country is safe until every country is prepared."