Opinion: What Ebola and Marburg are teaching us about the next pandemic

OpinionFirst Opinion What Ebola and Marburg are teaching us about the next pandemic Ecological and societal conditions driving infectious disease emergence are getting more complex Manage alerts for this article Email this article Share this article By Krutika Kuppalli and Placide MbalaJuly 1, 2026 Kuppalli is an infectious diseases physician and former World Health Organization medical officer. Mbala-Kingebeni is a Congolese virologist and the head of epidemiology and global health at the National Institute of Biomedical Research in the Democratic Republic of Congo. As the ongoing Bundibugyo Ebola outbreak spreads across the Democratic Republic of the Congo and Uganda, global attention has understandably focused on the absence of licensed vaccines and therapeutics for this rare species of Ebola virus. Yet one of the outbreak’s most consequential failures has received far less attention: our inability to rapidly and reliably diagnose the pathogen in the first place.Advertisement The current epidemic, which has caused more than 1,300 confirmed cases and over 375 confirmed deaths in DRC and has spread into neighboring Uganda, initially evaded detection not because clinicians failed to recognize viral hemorrhagic fever, but because many of the diagnostic tools deployed on the frontlines were designed for a different outbreak. The GeneXpert assays routinely used during Ebola responses were developed primarily to detect Zaire ebolavirus (EBOV), the species responsible for the devastating West African epidemic of 2014-2016 and most subsequent Ebola outbreaks. They did not reliably detect Bundibugyo ebolavirus (BDBV). As a result, patients with Ebola initially tested negative, allowing transmission to continue undetected for critical weeks. This should be a wake-up call.Advertisement Now, as the BDBV epidemic continues, Ugandan authorities are investigating cases of Marburg virus disease occurring amid the ongoing Ebola response. According to recent reports, Uganda reported to the World Health Organization that it had detected a Marburg virus disease outbreak in the western part of the country while investigations continue into additional suspected cases. Whether these reports ultimately represent a larger Marburg outbreak, isolated spillover events, or another pathogen entirely is almost beside the point. The fact that public health officials must even consider the simultaneous circulation of multiple high-consequence pathogens during a single regional emergency highlights a reality that our preparedness systems have failed to fully embrace: Pathogens do not organize themselves according to our testing algorithms. As scientists and physicians who have worked on Ebola outbreaks across Africa, including in West Africa, Uganda, and the Democratic Republic of the Congo, we have watched the current epidemic unfold with a familiar sense of frustration. Once again, we are learning that one of the greatest barriers to controlling an outbreak is often not the absence of vaccines, therapeutics, or public health expertise. It is the inability to rapidly determine what pathogen we are confronting in the first place. For decades, the global health community’s approach to outbreak diagnostics has been largely reactive and pathogen-specific. We build tests for the pathogen that caused the last major emergency, deploy them widely, and then discover during the next crisis that a different pathogen is circulating. This cycle has repeated itself across outbreaks of EBOV, Sudan virus, BDBV, and Marburg virus. But the same pattern has characterized our broader approach to infectious diseases. After SARS emerged in 2003, we developed SARS diagnostics. After the H1N1 influenza pandemic, we expanded influenza testing. Following the West African Ebola epidemic, we invested heavily in diagnostics for EBOV. During Covid-19, the world mobilized unprecedented resources to develop SARS-CoV-2 diagnostics. When mpox spread globally in 2022, laboratories rapidly established orthopoxvirus testing capacity.Advertisement While these investments have saved countless lives, they have also reinforced a dangerous assumption: that the next outbreak will resemble the last one. History repeatedly tells us otherwise. The ecological and societal conditions that drive infectious disease emergence are becoming increasingly complex. Climate change, conflict, environmental disruption, urbanization, population displacement, and increased human-animal interactions are creating opportunities for pathogens to emerge in new places and in new combinations. The regions currently affected by the BDBV outbreak sit at the intersection of these forces. Eastern DRC has experienced repeated outbreaks of Ebola, Marburg, mpox, plague, anthrax, and other emerging infections over the past two decades. In such environments, clinicians do not encounter neatly categorized pathogens. They encounter patients. A patient presenting with fever, gastrointestinal symptoms, hemorrhage, respiratory failure, encephalitis, or shock does not arrive labeled as having Ebola, Marburg, influenza, coronavirus, or a pathogen that has yet to be discovered. Yet our diagnostic systems often require us to decide which pathogen we believe is causing illness before we can determine what is actually there. This approach no longer makes clinical or public health sense. As the possible emergence of Marburg virus disease amid an ongoing Ebola outbreak shows, the presence of one outbreak does not preclude the simultaneous circulation of another. If the current investigations in Uganda confirm additional Marburg transmission, they would represent a stark reminder that our assumptions about how pathogens emerge and spread are often wrong. What is urgently needed is a shift from pathogen-specific diagnostics toward pathogen-agnostic diagnostic systems. For viral hemorrhagic fevers, this means developing deployable, validated diagnostic platforms capable of detecting all known pathogenic filoviruses while retaining the flexibility to identify novel or previously unrecognized viruses. Some broad-range molecular assays and next-generation sequencing approaches already exist in research settings.Advertisement This challenge extends well beyond filoviruses. We need diagnostic approaches designed around clinical syndromes rather than individual pathogens: severe respiratory illness platforms capable of identifying known and novel respiratory viruses; encephalitis panels capable of detecting emerging neurotropic pathogens; febrile illness diagnostics that can identify both expected and unexpected causes of disease; and surveillance systems capable of recognizing pathogens we have never seen before. The scientific tools to accomplish this already exist. Advances in multiplex molecular diagnostics, metagenomic sequencing, broad-range pathogen detection, and artificial intelligence-assisted surveillance have transformed our ability to identify infectious threats. What is needed now is sustained investment, regulatory support, and political will to translate these advances into operational tools for outbreak response, including for pathogens that have not yet caused global emergencies. This is not simply a technical challenge. It is a strategic imperative. The truth is that many of the pathogens that will threaten us in the coming decades have likely not yet been discovered. In an era defined by climate change, environmental disruption, conflict, displacement, and increasingly frequent zoonotic spillover events, we should expect pathogens to emerge in new combinations, in new places, and sometimes at the same time. If we continue to approach emerging infectious threats with the same diagnostic paradigms and tools, we will continue to achieve the same result: recognizing outbreaks only after they have already begun to spread. In outbreak response, diagnostics are not simply laboratory tools. They are the foundation upon which every other intervention rests. Without timely diagnosis, vaccines cannot be targeted, therapeutics cannot be deployed, contacts cannot be traced, and outbreaks cannot be contained. The next global health emergency may not be Ebola. It may not be Marburg. It may not be influenza, coronavirus, or any pathogen currently on our watch lists. Whatever it is, frontline clinicians and public health officials should not have to spend days or weeks determining what they are confronting. If we continue to prepare for tomorrow’s outbreaks with yesterday’s diagnostic tools and strategies, we should not be surprised when we get the same result: another epidemic recognized too late and too many lives lost.Advertisement Krutika Kuppalli, M.D., is an infectious diseases physician and former World Health Organization medical officer. She served as medical director of an Ebola treatment unit in Sierra Leone during the 2013–2016 West Africa Ebola epidemic and has supported Ebola preparedness and response efforts in Africa and globally. Placide Mbala-Kingebeni is a Congolese virologist and the head of epidemiology and global health at the National Institute of Biomedical Research in the Democratic Republic of the Congo. He is internationally recognized for his leadership in the response to Ebola virus disease outbreaks and for his contributions to emerging infectious disease surveillance and research in Africa. Letter to the editor Have an opinion on this essay? Submit a letter to the editor. drug development, infectious diseases, public health Submit a correction requestReprints Krutika Kuppalli Placide Mbala Newsletter Understand how science, health policy, and medicine shape the world every day Recommended First Opinion July 1, 2026 Maryland Gov. Wes Moore: How to improve young men’s mental health First Opinion June 30, 2026 Short-sighted new student loan caps elevate chiropractic care over critical health care professions Advertisement First Opinion June 30, 2026 Florida is the first state to require EKGs for high school athletes. 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