On May 17, 2026, the Director-General (DG) of the World Health Organization (WHO), after consulting with affected States Parties, determined that the epidemic of Ebola disease caused by Bundibugyo virus in the Democratic Republic of the Congo and Uganda constituted a public health emergency of international concern (PHEIC). This determination was made pursuant to Article 12 of the International Health Regulations (2005) (IHR). The DG clarified that while it met the criteria for a PHEIC, it did not qualify as a pandemic emergency as defined in the IHR. Following this, on May 19, 2026, the IHR Emergency Committee convened, advising in alignment with the DG's assessment. The Committee acknowledged the extremely challenging operational environment for the response and emphasized the need to incorporate contextual information for success. Consequently, the DG issued temporary recommendations to all States Parties to prepare for and respond to the PHEIC.

These temporary recommendations are tailored to different States Parties based on their associated public health risk from the Bundibugyo virus disease (BVD) epidemic. All current WHO interim technical guidance is accessible on the WHO website and will be updated with evolving scientific evidence and risk assessments. Implementation of these recommendations must fully respect the dignity, human rights, and fundamental freedoms of individuals, adhering to Article 3 of the IHR.

For States Parties with documented detection of Bundibugyo virus, specifically the Democratic Republic of the Congo and Uganda, the risk was assessed as "Very high" and "High" respectively, as of May 22, 2026. Uganda had reported two confirmed BVD cases, epidemiologically linked to the DRC, with no documented onward transmission. The epidemic is caused by the Bundibugyo virus (BDBV), for which no approved therapeutics or vaccines currently exist. Control relies on scaling up public health interventions, including declaring the epidemic a health emergency at national or sub-national levels, activating emergency management mechanisms, and establishing emergency operation centers. These measures encompass enhanced surveillance, case identification, contact tracing, infection prevention and control (IPC), risk communication, laboratory diagnostics, case management, and safe and dignified burials. Coordination mechanisms should be established at national and sub-national levels, maintaining registers of alerts, line lists of cases, and contact lists for 21-day monitoring. Security corridors, including cross-border, must be negotiated to ensure safe access for responders and healthcare access for communities. Daily notification of suspected, probable, and confirmed BVD cases to WHO is required.

Risk communication and community engagement are crucial, involving large-scale trust-building interventions through local leaders, community health workers, and Red Cross volunteers to promote early detection, isolation, contact monitoring, and safe burial practices. This includes addressing cultural norms that may impede participation and ensuring support for adherence to movement restrictions. Surveillance and laboratory capacities must be strengthened and decentralized, with dedicated response teams, active case finding, investigation of alerts within 24 hours, and scale-up of RT-PCR testing. Field laboratories should adhere to biosecurity and biosafety standards, noting that the GeneXpert platform cannot detect BDBV. Contact tracing performance must be continuously monitored.

Infection prevention and control in health facilities must be strengthened through systematic mapping, triage protocols, continuous training, sufficient PPE supplies, and channels for health workers to report exposures and access psychosocial support. Occupational exposures must be investigated. Community IPC capacity should also be built. Dedicated BVD isolation and treatment centers with trained staff and optimized intensive supportive care must be established, along with protocols for safe patient transfer and medical waste disposal. Survivor follow-up programs, including clinical care and psychosocial support, are essential. Maintenance of essential health services (e.g., malaria diagnosis, maternal and child health) with IPC equipment is also critical. Safe and dignified burials, conducted by well-trained personnel respecting family presence and cultural practices, must be ensured. Robust logistics support for medical commodities and IPC materials is necessary.

Border health, international travel, and mass-gathering events require enhanced surveillance at ground crossings, measures to prevent international travel by cases/contacts (unless for medical evacuation), and prevention of cross-border movement of human remains (unless bilateral agreements exist). Exit screening at points of entry, including questionnaires, temperature checks, and in-depth assessments for fever, must be implemented. Travelers with BVD-consistent illness should not be allowed to travel unless medically evacuated. Postponing mass gatherings should be considered. Research and development of medical countermeasures involve engaging partners to define laboratory strategies, implement clinical trials for therapeutics and vaccines, and establish expedited regulatory and ethics reviews, data sharing, and equitable access arrangements.

For States Parties with land borders adjoining those with documented BDBV detection, the regional risk was assessed as "High." These states must establish national coordination mechanisms, rapidly enhance readiness for BVD cases through active surveillance, community-based surveillance, access to qualified laboratories, health worker awareness and training, and rapid response teams for case and contact management. International contact tracing operations are necessary. Risk communication and community engagement must be intensified in border areas and points of entry. Simulation exercises for BVD alert management, cross-border coordination, sample referral, and rapid response team activation are recommended. Support for research, including regulatory and ethics reviews and data sharing, is also emphasized. Border health and international travel involve providing accurate information to travelers (discouraging travel to affected areas), enhancing border surveillance and coordination for detecting febrile illness and sharing contact information, pre-positioning supplies, activating health contingency plans at airports and ports, and coordinating with conveyance operators. Neither suspension of flights nor denial of entry to travelers from affected states is recommended, but any international traffic-related measure adopted must be reported to WHO. Detection of a suspected or confirmed BVD case, contact, or cluster of unexplained deaths should be treated as a health emergency, with immediate notification to WHO.

For all other States Parties, the risk was assessed as "Low." They must make arrangements to detect, assess, report, and manage travelers with unexplained febrile illness from affected areas, including disseminating case definitions, identifying testing laboratories, and isolation facilities. Information on risk and exposure minimization should be provided to NGOs and entities deploying personnel internationally. Preparation for evacuation and repatriation of nationals exposed to BVD is required. Public information on the epidemic and measures to reduce exposure should be provided, discouraging travel to affected areas. Border health and international travel recommendations include informing travel clinics and professionals, providing information to incoming travelers on symptoms, and coordinating with the transport sector for timely management of suspected cases and contact identification. Again, neither flight suspension nor entry denial is recommended. Any adopted international traffic measure must be reported to WHO, and any suspected, probable, or confirmed BVD case must be immediately notified to WHO. In the presence of a BVD case, the recommendations for States Parties with documented BDBV detection apply.

All States Parties are required to report quarterly to WHO on the status and challenges of implementing these temporary recommendations, using a standardized tool provided by WHO to monitor progress and identify national response gaps.