Congo ended its last Ebola epidemic with a vaccine. That vaccine does not apply to this one.

Ervebo is licensed against Zaire ebolavirus. This outbreak is Bundibugyo, a different species of the same virus family, and WHO's guidance on the difference is not hedged: "At present, there are no licensed vaccines for Sudan virus disease (SVD), Tai Forest virus disease, or Bundibugyo virus disease (BVD)" [4].

On treatment, the fact sheet is equally short: "For other Ebola diseases, such as SVD or BVD, there are no approved therapeutics" [6].

WHO convened experts in May to ask whether Ervebo might cross-protect anyway. The answer was that "evidence on cross-protection to other Ebola virus species remains limited and inconclusive," and that the vaccine "should not be used outside carefully designed research settings" [5]. Medecins Sans Frontieres said it plainly: the two approved vaccines work against "the most common virus responsible for Ebola disease - the Ebola (formerly known as Zaire) virus - not Bundibugyo" [7].

Where the numbers stand, with their dates attached

The counts move fast enough that a figure without a date is close to meaningless.

WHO, data as of July 15: 2,124 confirmed cases in DRC, 828 deaths, case fatality rate 39 percent [3].

DRC government, as of July 26: 3,200 cases, 1,405 deaths [12]. As of July 28: 3,442 cases, 1,521 deaths [13]. That later pair works out to 44 percent.

The two rates are not a contradiction. They are a trend. The rate ran 32.1 percent on July 5, 39 percent on July 15 and 44 percent on July 28. It is climbing.

The record it is about to pass

WHO's page for the 2018 to 2020 North Kivu outbreak, the one Ervebo helped end, records 3,481 cases and 2,299 deaths and calls it "the world's second largest Ebola outbreak on record" [14].

This outbreak stood at 3,442 on July 28, moving at roughly 120 cases a day.

One caveat belongs with that comparison and is usually dropped: 3,481 counts confirmed plus probable cases, while 3,442 counts confirmed cases only. They are not a like-for-like pair.

Two-thirds of the dead never reached a clinic

"About two-thirds of deaths are occurring in communities, among people who never receive care in a health facility," Tedros Adhanom Ghebreyesus said on July 16 [8].

The reasons are documented and they are plural. Armed conflict, named by Tedros in the same remarks: "Active armed conflict is hampering access to the affected areas, and hindering the response. Just yesterday, a treatment centre in Bunia was attacked" [8]. A July 15 attack on Nyakunde hospital and its treatment centre temporarily displaced international partners [13].

Burial practice, which Africa CDC's Jean Kaseya attributes deaths to directly, the handling of remains that stay highly infectious. Mistrust, including outright denial that the virus exists [13].

Pay, which is the most fixable of them. Health workers at the Elikya Ebola Treatment Centre in Bunia struck over unpaid wages and unsafe conditions. Martin Bolombi, one of them, put the position in a sentence: "We need to be paid, because in the meantime the disease is spreading" [11].

Surveillance has broken down underneath all of it. In Ituri, more than 80 percent of new cases trace to no known case, and test positivity runs above 40 percent [10].

The money

WHO and Africa CDC launched a joint continental plan in June asking for $518 million through November [9]. A month later Tedros reported a shortfall of "more than US$ 400 million" [8].

Roughly 77 percent of the plan is unfunded, in an outbreak with no licensed vaccine, where the main intervention left is getting people into care early.

What is being built

Countermeasures do exist in the pipeline. WHO's May review prioritised MBP134 and remdesivir for treatment, obeldesivir for post-exposure prophylaxis, and two candidate vaccines built specifically for this species: rVSV Bundibugyo from IAVI and ChAdOx1 Bundibugyo from Oxford and the Serum Institute of India [5]. CEPI has put $8.5 million into Hilleman Laboratories for Bundibugyo vaccine development [10].

None of them is approved, and none will arrive in time for this outbreak.

What is working is unglamorous. "Even without approved vaccines and treatments, 377 people have recovered, showing that with early diagnosis and safe care, this disease can be survived and stopped," Tedros said [8]. That is the entire toolkit, and it is the one the fighting and the funding gap are taking away.