Level 1 - Absolute Beginner

There is a very bad illness in Africa. The illness is called Ebola. It is in a country called the Democratic Republic of the Congo.

More than 9,000 people are sick. More than 4,000 people have died. This is the worst Ebola outbreak in the country's history.

Doctors have no medicine for this kind of Ebola. There is no vaccine for it yet. Scientists want to test a new vaccine soon.

The work is very hard. There is a war in the east of the country. Some people do not trust the doctors. The illness is now in seven areas.

illness

A sickness or disease.

Ebola

A very dangerous disease that causes fever and bleeding.

country

A land with its own government, like France or Kenya.

sick

Not healthy; ill.

die

To stop living.

medicine

Something you take to get better when you are ill.

vaccine

An injection that stops you getting a disease.

trust

To believe that someone is good and honest.

Level 2 - Elementary

The Democratic Republic of the Congo is facing the worst Ebola outbreak in its history. On Tuesday, October 13, the Health Ministry reported 9,066 confirmed cases and 4,381 deaths. That means almost half of the people who catch the virus do not survive.

This outbreak is caused by the Bundibugyo strain of Ebola. There are vaccines and treatments for some other kinds of Ebola, but not for this one. The virus has now spread to seven provinces in the north and east of the country.

Stopping the outbreak is extremely difficult. Many people in local communities do not believe the official story and think the disease is an excuse for officials to take money. In September, a local politician was beaten to death after he defended the government's response on the radio.

Fighting also blocks the response. The M23 rebel group is at war with government forces, which makes it hard to bring medicine and equipment to remote villages. Dr Chikwe Ihekweazu of the World Health Organization said on Tuesday that a trial to test a vaccine against this strain is being prepared for the coming weeks.

outbreak

A sudden start and spread of a disease in an area.

confirmed case

A person who has been tested and definitely has the disease.

survive

To stay alive after a danger or illness.

strain

A particular type or version of a virus.

spread

To move to more places or more people.

province

A large administrative region inside a country.

community

The people who live in one area.

remote

Far away from towns and hard to reach.

Level 3 - Intermediate

The Ebola epidemic in the Democratic Republic of the Congo has crossed a grim threshold. On Tuesday, October 13, the Health Ministry confirmed 9,066 cases and 4,381 deaths, a case fatality rate approaching 50 percent. It is now the largest and deadliest outbreak in Congolese history, and globally its death toll is second only to the 2014 to 2016 West African epidemic, which recorded 28,600 confirmed cases and more than 11,000 deaths across Guinea, Liberia and Sierra Leone.

What makes this epidemic different is the pathogen itself. The outbreak stems from the Bundibugyo strain, a less common species of Ebola virus for which no vaccine or therapeutic has been approved. The licensed vaccines that helped contain previous Congolese outbreaks were developed against the Zaire strain and offer no reliable protection here. Dr Chikwe Ihekweazu, executive director of the WHO Health Emergencies Programme, said on Tuesday that a clinical trial to evaluate vaccine efficacy against Bundibugyo is being prepared for deployment in the coming weeks.

The response is also fighting the conditions around it. The virus has reached seven provinces across the north and east, regions where the M23 rebel group remains locked in conflict with government forces, severely restricting the movement of medical supplies and personnel into remote districts. Community mistrust compounds the problem. In many affected areas residents suspect the epidemic is a pretext for officials to divert aid money, and in September a local politician in the east was beaten to death after defending the government's handling of the outbreak on a radio broadcast.

The timeline suggests the outbreak was detected late. It was officially announced in mid-May, but some epidemiologists believe transmission may have begun as early as February, giving the virus months to circulate undetected. The epidemic has also breached borders. Kenya recorded its first imported case, a Kenyan national who had been living in the DRC and travelled through Uganda to Nairobi, where he later died. Uganda itself reported 20 cases and two deaths earlier in the year before being declared Ebola-free in August.

epidemic

A disease outbreak affecting a large number of people in a region.

case fatality rate

The share of people with a confirmed disease who die from it.

pathogen

An organism such as a virus or bacterium that causes disease.

therapeutic

A treatment or drug used to cure or relieve a disease.

efficacy

How well a treatment works under controlled trial conditions.

pretext

A false reason given to hide the real one.

epidemiologist

A scientist who studies how diseases spread through populations.

transmission

The passing of a disease from one person to another.

Level 4 - Advanced

Epidemics are rarely defeated by medicine alone; they are defeated by medicine delivered into a society willing to receive it. The Ebola emergency now unfolding in the Democratic Republic of the Congo, which on Tuesday reached 9,066 confirmed cases and 4,381 deaths, is a demonstration of what happens when neither condition holds. The case fatality rate hovers near 50 percent, making this the most lethal outbreak in Congolese history and, in absolute mortality, the second worst the world has recorded, surpassed only by the West African epidemic of 2014 to 2016 and its 28,600 cases and 11,000-plus deaths across Guinea, Liberia and Sierra Leone.

The pharmacological problem is specific and unforgiving. Previous Congolese outbreaks were eventually contained with ring vaccination campaigns built around licensed products developed against the Zaire ebolavirus species. This epidemic is driven by Bundibugyo, a rarer species against which those vaccines confer no dependable cross-protection and for which no therapeutic has been licensed anywhere. The international response is therefore attempting something closer to research than to deployment: Dr Chikwe Ihekweazu, executive director of the WHO Health Emergencies Programme, confirmed that a clinical trial to assess vaccine efficacy against Bundibugyo is being readied for the DRC within weeks, an undertaking that requires stable field sites in precisely the districts where stability is least available.

Those districts are the second half of the problem. Transmission has established itself across seven provinces in the north and east, a theatre in which the M23 insurgency continues to contest government control, degrading the logistics of cold chains, contact tracing and burial teams alike. Overlaying the insecurity is an erosion of public trust that has turned lethal. In many communities the epidemic is read as an elaborate mechanism for siphoning aid, a suspicion with sufficient historical grounding to be resistant to correction; in September a local politician in the east was beaten to death after using a radio broadcast to defend the official response. When defending epidemiology becomes physically dangerous, surveillance data degrades, and degraded surveillance is how outbreaks become epidemics.

The chronology suggests the window for cheap containment closed long before anyone opened it. The outbreak was declared in mid-May, yet several epidemiologists suspect sustained human transmission dates to February, implying roughly a quarter of a year of undetected circulation in a region with porous borders and heavy cross-frontier movement. The consequences have already travelled: Uganda recorded 20 cases and two deaths before being declared Ebola-free in August, and Kenya registered its first imported infection in a Kenyan national who had been resident in the DRC and transited Uganda to Nairobi, where he died. Each exported case is a reminder that the arithmetic of this outbreak is not confined to Congolese provinces, and that a vaccine trial launched into an active war zone is now the most plausible route to ending it.