Perspective

Introduction
The 2026 Bundibugyo Ebola outbreak in the Democratic Republic of the Congo (DRC) and Uganda represents an important test of global and regional epidemic preparedness efforts [1–3]. Unlike outbreaks caused by the Zaire strain of Ebola virus, for which vaccines and therapeutics are available, no licensed vaccines, approved therapeutics, or point-of-care diagnostics currently exist for Bundibugyo Ebola virus disease [4,5]. Countries, therefore, face the difficult challenge of responding to an ongoing public health emergency while simultaneously generating evidence to support outbreak control.

In our view, the most important lesson from the outbreak is not simply the absence of medical countermeasures but the lack of systems that allow research to begin rapidly during emergencies. The outbreak demonstrates that preparedness failures often occur long before the first case is detected. When research systems are not ready before an outbreak begins, opportunities to generate evidence and accelerate response efforts are inevitably delayed.

As of 15 June 2026, the outbreak had resulted in 856 confirmed cases and 198 deaths across affected districts in DRC and Uganda, including infections among healthcare workers [1–3]. These events underscore continuing challenges in infection prevention and control, surveillance, and outbreak response. However, they also reveal deeper structural weaknesses that deserve greater attention.

Research Readiness: The Missing Pillar of Preparedness
We argue that the Bundibugyo outbreak exposes a critical gap in epidemic preparedness: research readiness. While governments and international partners have invested heavily in surveillance systems, laboratory infrastructure, emergency operations centres, and workforce development, comparatively less attention has been devoted to ensuring that research can be activated rapidly during public health emergencies.

Research readiness encompasses pre-approved protocols, standing ethics and regulatory mechanisms, trained investigators, established clinical trial networks, emergency financing arrangements, and community engagement structures that can be mobilized immediately when an outbreak occurs. These capacities cannot be developed in the middle of a crisis. By the time transmission is detected, valuable time has already been lost if such systems are not in place.

The importance of research readiness has gained increasing global recognition through CEPI’s 100 Days Mission [6,7], WHO’s R&D Blueprint, and Africa CDC’s health security initiatives. These frameworks have established ambitious goals for accelerating vaccine development and strengthening research capacity. However, our experience suggests that operationalizing these frameworks at national and regional levels remains challenging.  The Bundibugyo outbreak illustrates that even when scientific expertise is available, the absence of operational research systems can delay evidence generation and response efforts. From our perspective, the outbreak reinforces the need to institutionalize research readiness as a core component of epidemic preparedness across Africa.

In the context of the 2026 Bundibugyo outbreak, both the Democratic Republic of the Congo and Uganda have established national ethics committees and regulatory authorities responsible for reviewing research protocols. The DRC’s Comité National d’Éthique de la Santé (CNES) [8] and Uganda’s National Council for Science and Technology (UNCST) and National Drug Authority (NDA) [9,10] provide formal oversight mechanisms for health research. However, our experience suggests that despite these bodies being operational, pre-approved protocols specifically designed for Bundibugyo virus disease were not available at the outset of the outbreak [11]. This created delays in initiating clinical research while protocols underwent review, often taking several weeks to complete [12]. The absence of regional mutual recognition mechanisms for ethics approvals further complicated cross-border research coordination, as investigators seeking to conduct studies across both countries were required to navigate separate review processes [13]. This experience underscores the importance of establishing standing ethics review mechanisms and pre-approved, adaptable protocols that can be rapidly activated during emergencies.

We wish to clarify that our argument is not that research is absent during outbreaks. Indeed, significant research efforts have been mounted during the Bundibugyo outbreak, including investigations into therapeutics, diagnostics, and epidemiological characteristics of the disease. Rather, we contend that the speed with which research can be initiated is constrained by the absence of pre-positioned protocols, standing ethics mechanisms, and clinical trial networks. This distinction between research activity and research readiness is central to our argument.

Why the Bundibugyo Outbreak Matters for West Africa
The lessons from Bundibugyo are particularly relevant for West Africa. The 2014–2016 Ebola epidemic, which resulted in more than 28,000 cases and over 11,000 deaths, transformed thinking about health security across the region [14,15]. In response, governments and partners invested substantially in surveillance systems, laboratory infrastructure, emergency operations centres, workforce development, and regional coordination mechanisms.

The West African Health Organization (WAHO), supported by Member States and development partners, has played a central role in strengthening regional preparedness [16]. Through initiatives such as the Regional Disease Surveillance Systems Enhancement (REDISSE) project, countries have improved disease surveillance, laboratory capacity, and outbreak response capabilities [17]. More recently, WAHO, CEPI, and ECOWAS Member States have collaborated through the Lassa Fever Coalition to advance vaccine preparedness, research readiness, and access planning for future epidemic threats [18].

These investments have produced measurable progress. However, our experience suggests that preparedness remains uneven across countries and that many gains have not yet been fully institutionalized. The Bundibugyo outbreak, therefore, offers an opportunity to reflect on persistent vulnerabilities that could undermine future responses.

Understanding these research readiness challenges in West Africa requires examining the broader preparedness context, as the following section demonstrates how general preparedness gaps intersect with and compound research readiness deficiencies.

Research Preparedness Gaps in West Africa
In this section, we examine specific gaps in research preparedness highlighted by the Bundibugyo outbreak. While these gaps intersect with broader health security challenges, our focus is on the aspects that directly affect the conduct of research during emergencies.

Despite notable progress, several weaknesses continue to affect epidemic preparedness in West Africa, each with direct implications for research readiness.

Each of these gaps has direct implications for research readiness. For example, when regulatory approval processes are fragmented across countries, research protocols requiring multi-site approval face significant delays. When community trust is fragile, recruitment for clinical trials becomes more challenging. The following sections examine these challenges through the lens of their impact on research readiness.

1. Regulatory and ethical review harmonization

While national regulatory authorities and ethics committees have strengthened considerably over the past decade, differences in procedures across West African countries can delay the approval of research protocols and emergency use authorizations. Such delays become particularly problematic when no licensed countermeasures exist, and rapid evidence generation is essential.

Impact on research readiness: When research protocols require approval from multiple national regulatory bodies and ethics committees, the cumulative review time can extend to several months. This creates a critical bottleneck for multi-country clinical trials and observational studies. The absence of mutual recognition mechanisms or harmonized review processes means that investigators cannot leverage approvals from one country to expedite review in another. During the 2014–2016 Ebola epidemic, delays in protocol approval were identified as a major barrier to generating evidence on candidate therapeutics and vaccines [19,20]. This challenge persists, underscoring the need for regional regulatory harmonization and parallel review mechanisms.

2. Clinical trial networks and research infrastructure

While genomic sequencing and laboratory infrastructure have expanded significantly across West Africa, these capacities are often concentrated in major urban centres, leaving vulnerable areas with limited access to advanced diagnostics and research opportunities [21]. Furthermore, the networks of trained investigators, clinical trial sites, and research coordinators required for emergency research remain unevenly distributed.

Impact on research readiness: The absence of pre-positioned clinical trial networks means that when an outbreak occurs in a remote or underserved area, investigators must establish research infrastructure from scratch. This includes identifying suitable trial sites, training local staff in research protocols and good clinical practice, and establishing specimen transport and laboratory testing pathways. These activities can take weeks or months, time that is critical during an expanding outbreak. The Bundibugyo outbreak highlighted this challenge, as research teams had to rapidly establish capacity in affected districts while simultaneously responding to the emergency [22].

3. Emergency research financing

Regional and international funding instruments have improved preparedness capacity, but disbursement procedures often remain lengthy relative to the speed at which outbreaks evolve [23]. This creates a recurring mismatch between epidemiological urgency and financial responsiveness.

Impact on research readiness: Research during outbreaks requires rapid funding for activities including protocol development, staff deployment, laboratory supplies, participant compensation, and data management. When funding mechanisms require lengthy application and review processes, research activities are delayed at precisely the moment when timely evidence is most needed. The inability to access pre-positioned research funds or rapid disbursement mechanisms can result in missed opportunities to evaluate candidate countermeasures or characterize disease epidemiology. The Bundibugyo experience reinforces the need for pre-negotiated research funding arrangements that can be activated within days rather than weeks.

4. Community engagement for research

Experiences from Ebola, COVID-19, and other outbreaks have repeatedly demonstrated that public trust is essential for effective surveillance, vaccination, contact tracing, and treatment efforts. Yet misinformation, insecurity, and social distrust continue to threaten response effectiveness in many settings [24].

Impact on research readiness: Community trust is particularly critical for research during outbreaks. Clinical trials require informed consent, willingness to participate, and adherence to study protocols, all of which depend on community acceptance. When trust is fragile, recruitment for research studies becomes challenging, potentially compromising the scientific validity and generalizability of findings. Community engagement structures cannot be established during an emergency; they require sustained investment in trusted local systems and community-led approaches. The Bundibugyo outbreak demonstrated that communities with pre-existing relationships with health authorities and researchers were more willing to participate in research activities compared to communities where such relationships had not been cultivated [25]

5. Data sharing and research coordination

Although regional surveillance frameworks exist, operational collaboration often depends on informal relationships among individuals rather than permanently institutionalized systems [26]. This dynamic was evident during the 2014-2016 Ebola response, where collaboration between formal and informal actors was shaped by interpersonal relationships and power dynamics rather than solely by established protocols.

Impact on research readiness: Multi-country research requires pre-agreed protocols for data sharing, including mechanisms for data harmonization, access, ownership, and publication. When these protocols are not established before an emergency, disputes can arise that delay analysis and dissemination of findings. The Bundibugyo outbreak underscored this challenge, as investigators in DRC and Uganda needed to coordinate research activities while navigating different national data governance frameworks. Establishing shared data governance frameworks in advance, as has been done through the Lassa Fever Coalition, can help address this challenge and accelerate evidence generation during outbreaks [18].

Practical lessons from the Lassa Fever Coalition: A replicable model for research preparedness
The Lassa Fever Coalition in West Africa provides a practical example of how research readiness can be institutionalized through regional collaboration. Established through a partnership between the West African Health Organization (WAHO), CEPI, ECOWAS Member States, and other partners, the Coalition has developed an operational governance structure and concrete mechanisms that are directly applicable to research preparedness for other epidemic threats [18].

Governance structure and institutional framework
The Coalition’s governance model offers several practical lessons for institutionalizing research readiness. The structure comprises four key components, as documented in the Coalition’s official framework:

First, the Lassa Governance Entity (LGE) serves as the primary decision-making body, composed of representatives from countries and core partners. The LGE is collectively responsible for formulating recommendations aligned with the governance bodies of constituent partners to achieve the Coalition’s objectives. Its first meeting was held on 16 January 2025, demonstrating the Coalition’s operational status.

Second, National Coalitions have been established to bring together relevant stakeholders at the country level. These national platforms deliberate and provide country-level inputs to working group recommendations submitted to the LGE. To date, National Coalitions have been established in Nigeria, Liberia, and Sierra Leone, providing a replicable model for multi-country coordination.

Third, Working Groups deliberate and develop recommendations on specific thematic areas, submitted for review and ratification by the LGE. These groups enable focused technical work on priority issues such as regulatory pathways, clinical trial networks, and community engagement.

Fourth, the WAHO Secretariat provides convening and coordination functions for the LGE, countries, and working groups, and defines the overall agenda of the Coalition. This institutional home ensures sustainability beyond individual projects or funding cycles.

Key achievements to date

• Establishment of a West Africa-owned governance platform
• Creation of National Lassa Coalitions with strengthened stakeholder engagement and advocacy
• Development of the first Regional Roadmap for a Lassa vaccine research and policy agenda

Relevance to broader epidemic preparedness
These practical elements of the Lassa Fever Coalition model are replicable for other epidemic threats, including Bundibugyo Ebola virus disease. The Coalition demonstrates that research preparedness requires sustained investment in governance structures, systems, and relationships, not merely the development of scientific tools. The Coalition’s five guiding principles further reinforce this approach: ensuring that affected countries have safe, effective, and high-quality vaccines to protect their populations adequately and equitably, according to their own conditions of use.

Moving from crisis response to sustainable preparedness
The Bundibugyo outbreak reminds us that preparedness is not merely a technical challenge. It is fundamentally political, institutional, and social.

Based on lessons from Bundibugyo and West Africa’s recent experience, we propose several priorities for strengthening preparedness:

1. Institutionalize cross-border coordination through formal agreements, joint planning mechanisms, and routinely tested standard operating procedures.
2. Establish emergency financing mechanisms capable of releasing resources within days rather than weeks.

• Harmonize regulatory and ethical review processes for emergency research and investigational products across the region.

1. Expand laboratory and genomic surveillance capacity beyond major urban centres and integrate these systems into routine public health functions.
2. Institutionalize research readiness through pre-approved protocols, standing clinical research networks, emergency activation procedures, and regional coordination platforms.
3. Strengthen risk communication and community engagement through sustained investment in trusted local systems and community-led approaches.

• Embed epidemic preparedness within national and regional development strategies to ensure sustainability beyond donor-funded projects.