The Political Epidemiology of Preparedness

How Great-Power Competition for Critical Minerals Shapes Ebola Response and Biodefense

The Political Epidemiology of Preparedness

What does a deadly Ebola outbreak have to do with cobalt mines and the global race for critical minerals? Everything, if you follow the incentives.

The tragedy unfolding in eastern Congo reveals how geopolitical priorities shape public health preparedness, outbreak response, and ultimately whether a controllable epidemic is stopped early or allowed to become an international emergency.

Analysis by Robert W. Malone, MD, MS

Summary:

An outbreak of Bundibugyo Ebola virus has already claimed roughly six hundred lives in eastern Congo, and it continues to spread. This is not an unstoppable virus. We have known for decades that classical public health measures, including rapid case identification, isolation, contact tracing, safe burial practices, and community engagement, can bring Ebola outbreaks under control. Yet those same measures are failing.

The reasons are painfully familiar. Healthcare workers and responders are going unpaid. Armed groups make many affected areas inaccessible. Local communities distrust both their own governments and outside institutions. Public health infrastructure has been allowed to erode. And while no licensed vaccine or therapeutic currently exists for Bundibugyo Ebola, that is only one symptom of a much larger preparedness gap.

This essay argues that the problem runs far deeper than one neglected virus. The uncomfortable truth is that public health preparedness, medical countermeasure development, and outbreak response are shaped as much by political and economic incentives as by disease burden. The world mobilizes rapidly once a crisis threatens wealthy nations. It invests far less consistently in preventing those crises where they begin.

In eastern Congo, those incentives are increasingly influenced by the global race for critical minerals. The cobalt, coltan, and gold beneath the soil command sustained geopolitical attention. The health of the people living above those resources too often does not. That reality has profound implications not only for Ebola, but also for preparedness, biodefense, and the strategic responsibilities that accompany competition for critical resources. If the United States intends to secure those resources as part of an America First strategy, then long-term public health preparedness in the regions that produce them should also be viewed as a matter of American national security.

The Essay:

I began with what I thought was a straightforward question. Why is an Ebola virus that we have known how to contain for decades still spreading, month after month, with no realistic end in sight? I assumed the answer would be found in the biology of the virus or in the failure to negotiate an “Ebola Truce” that would allow public health workers to do their jobs.

Instead, I found myself following a very different trail. The answer has surprisingly little to do with virology and everything to do with the political economy of infectious disease. It is a story about how strategic competition over one of the world’s most resource-rich regions shapes public health investment, outbreak preparedness, and the development of medical countermeasures. Ultimately, those decisions determine whether a controllable outbreak is rapidly contained or allowed to smolder. The virus is the catalyst. The real story is the public policy and underlying geopolitical conflict that determines the response.

On May 15, 2026, the Democratic Republic of the Congo declared its seventeenth Ebola outbreak since the virus was first identified in 1976. Two days later, the World Health Organization declared it a Public Health Emergency of International Concern. This time the culprit is Bundibugyo Ebola virus, a relatively uncommon species first identified in neighboring Uganda in 2007 and responsible for only two previous outbreaks.

By early July, official reports listed roughly 1,700 cases and about 600 deaths. The real numbers are almost certainly higher. Epidemiologists at Imperial College London concluded that many infections and deaths were never counted, particularly in remote communities where people died before ever reaching medical care.

Understanding the biology of this virus is important because it explains why this outbreak should be controllable.

Bundibugyo Ebola kills roughly one-quarter to one-half of those it infects. Like all Ebola viruses, it spreads through direct contact with the blood or bodily fluids of someone who is already sick, or who has recently died. People are not contagious during the incubation period, which lasts between two and twenty-one days.

Unlike the better-known Zaire strain, Bundibugyo often does not cause dramatic hemorrhaging. Early symptoms look much more like malaria or typhoid fever, allowing cases to circulate unnoticed unless laboratory testing is performed. That appears to have happened in the mining communities of Ituri Province, where the virus spread for weeks before anyone recognized what they were dealing with.

Even so, this is not an uncontrollable virus.

To be clear, effective vaccines and monoclonal antibody treatments exist for the Zaire strain of Ebola but not for Bundibugyo Ebola. Those advances have saved lives and strengthened outbreak response. They have not replaced the fundamentals of Ebola control. Every successful response has depended first on rapid case identification, isolation of infected patients, contact tracing, safe burial practices, community engagement, and public trust. Vaccines and therapeutics complement those measures. They cannot compensate for their absence.

A pathogen that spreads only through close physical contact with symptomatic patients is exactly the type of outbreak that traditional public health measures were designed to stop. The playbook has changed very little over the decades. Find cases early. Isolate infected patients. Identify and monitor contacts for twenty-one days. Ensure safe burials. Protect healthcare workers. Build trust with local communities.

The Congo has done this before. This is its seventeenth Ebola outbreak, and the country has also responded to numerous outbreaks of other viral hemorrhagic fevers over the past several years. The expertise exists. The public health playbook exists.

Which brings us to the central question.

If we already know how to stop Ebola, why is this outbreak still growing?

Why control is failing

If we know how to stop Ebola, why isn’t this outbreak coming under control?

The answer has surprisingly little to do with the virus itself. It has everything to do with the conditions in which the virus is spreading.

It begins with security.

Eastern Congo remains an active conflict zone. Large areas are controlled or contested by armed groups, making it dangerous, and in some places impossible, for public health teams to reach infected communities. During the 2018 to 2020 Ebola outbreak in North Kivu, the World Health Organization documented nearly 400 attacks on healthcare workers and treatment centers in a single year (WHO 2020). The same pattern is repeating today. During this outbreak, a community health investigator was beaten by a mob while tracing contacts in the village of Tutu (Africanews 2026). The WHO Director-General has appealed for a ceasefire simply to allow healthcare workers to do their jobs (WHO 2026). You cannot isolate patients, trace contacts, or break chains of transmission if you cannot safely enter the affected communities.

Then there is trust.

Public health succeeds only when people trust those trying to help them. If families hide sick relatives, refuse isolation, or conduct traditional burial ceremonies involving direct contact with the deceased, Ebola spreads exactly as the virus evolved to spread. During the North Kivu outbreak, surveys found that only about one-third of local residents trusted government authorities, while roughly one-quarter doubted the outbreak even existed (Vinck et al. 2019). Given the region’s history, that skepticism should surprise no one. For generations, outside powers have arrived to extract wealth from eastern Congo while offering little in return. Communities that have repeatedly experienced exploitation are naturally suspicious when outsiders arrive wearing protective suits and asking questions. The legacy stretches back at least to the Congo Free State under King Leopold II, when millions suffered under a system built on resource extraction (Hochschild 1998).

Money is another part of the problem.

An outbreak response is only as effective as the people carrying it out. Yet doctors, nurses, contact tracers, and burial teams in Ituri recently went on strike after working for weeks without pay and often without adequate protective equipment (Africanews 2026). The WHO’s own emergencies chief acknowledged that the response is operating at only a fraction of the capacity required, rating it just three or four on a ten-point scale (UN News 2026). A public health strategy built on surveillance, contact tracing, safe burials, laboratory support, and community engagement cannot succeed if the people responsible for carrying out those tasks are unpaid.

Finally, there is the broader preparedness gap.

Preparedness is more than vaccines. It includes surveillance systems, diagnostic laboratories, trained epidemiologists, logistics, therapeutics, and vaccines. Bundibugyo Ebola exposes weaknesses across that entire system.

To be clear, effective vaccines and monoclonal antibody treatments exist for the Zaire strain of Ebola but not for Bundibugyo Ebola (WHO 2026). That represents an important gap, but it is only one part of the story. The development of effective vaccines against Zaire Ebola is a remarkable scientific achievement and has undoubtedly saved lives. Since 2018, ring vaccination has become an important addition to the outbreak response. But history and WHO guidance are clear: vaccines do not replace classical public health. Every successful Ebola response has depended first on rapid case identification, isolation of infected patients, contact tracing, safe burial practices, community engagement, and public trust. Vaccines and therapeutics strengthen that response. They cannot substitute for it.

What is Ring Vaccination? Ring vaccination is a targeted public health strategy used to contain infectious disease outbreaks by vaccinating individuals most likely to be infected, rather than the general population. This approach creates a protective "ring" of immunity around confirmed cases by immunizing their close contacts and the contacts of those contacts, seeking to effectively interrupt chains of transmission.

Nor should the importance of vaccines be minimized. Ebola is a devastating disease with a high case-fatality rate. During an active outbreak, a vaccine that provides meaningful protection can save lives. The risk-benefit calculation is fundamentally different from that of vaccines used against diseases with much lower mortality, which is why vaccine products with a high adverse event rate may be accepted as Ebola interventions.

Which brings us to the obvious question.

Bundibugyo Ebola was first identified nearly twenty years ago. Why are there still no licensed vaccines, therapeutics, or other pathogen-specific countermeasures? The answer is not simply scientific. It is also economic, political, and strategic.

That is where this story begins.

The Preparedness Gap

Why are there still no licensed vaccines or therapeutics for Bundibugyo Ebola almost twenty years after the virus was first identified?

The better question is why the world was so unprepared for this outbreak.

Preparedness is not just vaccines. It includes surveillance, diagnostics, laboratory capacity, trained epidemiologists, logistics, therapeutics, and vaccines. The current outbreak has exposed gaps across that entire system.

The reason is straightforward. Preparedness for high-consequence infectious diseases is not driven primarily by disease burden. It is driven by markets, politics, and the perceived threat to wealthy nations.

The countermeasure pipeline illustrates the problem.

Today there are ninety-four filovirus countermeasures somewhere in development. Roughly fifty target Zaire Ebola, twenty-two target Sudan virus, and thirty-eight target Marburg. None are specific for Bundibugyo Ebola (Impact Global Health 2026).

That is not because Bundibugyo presents an insurmountable scientific challenge. It is because there has never been a sustained commercial market or political imperative to develop products against it.

Zaire Ebola became the focus of global investment because it produced the outbreaks that captured the attention of the developed world. The West African epidemic of 2014 to 2016 reached Europe and the United States. The North Kivu outbreak became the second largest Ebola epidemic on record. Investment followed. Vaccines and monoclonal antibody therapies followed. Bundibugyo never generated the same urgency.

This is not a failure of science. It is the predictable consequence of how preparedness is financed.

The communities at greatest risk are among the poorest on Earth. They cannot create a commercial market large enough to sustain private investment. Governments can close that gap, but public funding follows political attention. When a crisis (or promoted fear of a crisis) dominates the headlines, money pours in. When the headlines fade, so does the funding. The result is a familiar cycle of panic, investment, complacency, and neglect (Impact Global Health 2026).

There is another weakness in this system.

Ebola research has become overwhelmingly dependent on a single sponsor. The United States government financed roughly 42 percent of global Ebola research and development in 2015. By 2024, that figure had climbed to approximately 88 percent (Impact Global Health 2026). That concentration creates its own vulnerability. When one government provides nearly all of the funding, changes in political priorities ripple across the entire preparedness enterprise. Recent reductions in U.S. global health spending weakened surveillance systems, community health programs, and outbreak response capacity just as eastern Congo needed them most.

Now the cycle is repeating itself.

Only after the outbreak was declared did significant new funding begin to appear. The U.S. State Department pledged $50 million to the Coalition for Epidemic Preparedness Innovations (CEPI) for Bundibugyo countermeasure development and committed more than $270 million to the broader outbreak response (U.S. Department of State 2026). The fact that the funding commitment came from the State Department rather than the U.S. Department of Health and Human Services speaks volumes about the executive branch's assessment of the relative importance of geopolitics versus domestic health risk.

Africa CDC rapidly assembled one of the most ambitious research programs ever launched for a newly emerging Ebola strain, including accelerated work on diagnostics, therapeutics, post-exposure prophylaxis, and a Bundibugyo-specific vaccine (Africa CDC 2026). That effort is commendable, but it also illustrates the central failure of the current system. We are assembling the tools needed to fight this virus only after the outbreak has become an international emergency.

This is the pattern.

Preparedness is chronically underfunded. Crisis triggers investment. Once the emergency subsides, the investment fades until the cycle begins again.

Even now, the response remains under-resourced. Africa CDC has appealed for an additional $18 million to complete its therapeutics program. The funding gap affects not only post-exposure prophylaxis trials but also the contact tracing required to conduct those studies (Africa CDC 2026). In other words, the same financial architecture that delayed the development of countermeasures is now slowing the public health response needed to evaluate and deploy them. Which lands right back on the unpaid public health workers who are now on strike rather than doing the critical work of contact tracing, education, and all the other mundane tasks that are the only things proven to slow or stop the current outbreak.

The mineral interface

This is where the story changes.

The Ebola outbreak in eastern Congo is not unfolding in an isolated corner of the world. It is unfolding in one of the most strategically valuable pieces of real estate on the planet.

The outbreak is centered around the mining district of Mongbwalu. Beneath the surrounding hills lie rich deposits of gold, coltan, cobalt, and other critical minerals that power everything from smartphones and electric vehicles to satellites and advanced weapons systems. The World Health Organization has identified mining activity and the movement of workers and traders as important drivers of the outbreak (WHO 2026). The same roads that move minerals also move Ebola.

What is Coltan? This black ore is critical for modern technology because refined tantalum is used to manufacture tantalum capacitors, which are essential components in mobile phones, laptops, automotive electronics, and electric vehicle batteries. No coltan, no digital tech, no data centers, no AI, no Teslas.

The conflict is inseparable from that reality.

The armed groups that block access to villages, attack healthcare workers, and make contact tracing impossible finance their operations through a combination of extortion, illegal taxation, and control of lucrative mineral resources. In many parts of eastern Congo, armed groups profit directly from gold and conflict minerals by controlling mines, taxing miners and traders, and smuggling minerals into international supply chains (U.S. Department of the Treasury 2026; GAO 2024; New Lines Institute 2026). The insecurity that frustrates outbreak control is therefore closely intertwined with the struggle for control of some of the world's most valuable mineral deposits.

Now, place that local conflict into a global context.

Control of critical minerals and rare earths has become a central objective of twenty-first century geopolitics. The United States and China are competing to secure supply chains that are increasingly viewed as matters of national security. The Democratic Republic of the Congo sits at the center of that competition. Washington has responded with new diplomatic initiatives, strategic partnerships, and investment agreements designed to strengthen American access to Congolese mineral resources while reducing dependence on Chinese-controlled supply chains (PassBlue 2026; Al Jazeera 2026a).

The contrast is impossible to ignore.

When critical minerals are at stake, governments think in decades, invest billions of dollars, and negotiate at the highest diplomatic levels. When Ebola strikes the communities living above those minerals, funding arrives only after the outbreak is underway, frontline healthcare workers go unpaid, and researchers scramble to develop countermeasures that should have existed years earlier.

That is not simply a coincidence. It is a reflection of priorities.

The minerals are viewed as strategic assets. The people living above them too often are not. This has been the case for as long as empires have existed.

Persons as terrain

Step back from this outbreak and a larger pattern comes into focus.

Throughout history, whenever great powers have competed for resources buried beneath someone else’s land, they have had to answer a simple question: What value do the people living above those resources have?

Sometimes they are viewed as an asset. Healthy workers produce wealth, pay taxes, and support economic growth. Under those conditions, governments and companies build roads, schools, hospitals, and clinics, not simply out of charity, but because doing so serves their own long-term interests. Economists have long treated human beings as capital, valuing the labor, skill, and health embodied in a population as a source of wealth.

Under other conditions, local residents are sometimes viewed as part of the landscape.

When the objective is the resource rather than the society, people become something to work around rather than something to invest in. The priority becomes securing the mine, the transportation corridor, the refinery, and the supply chain. The health of the surrounding population becomes secondary.

When great powers compete, the calculus changes.

A nation that expects to benefit from a territory for generations has an incentive to invest in its long-term stability and productivity. A nation racing to secure critical resources before a rival does faces a different set of incentives. The planning horizon contracts. Immediate access to the resource takes precedence over the slow work of building institutions, improving public health, or investing in the people who live there. The objective is no longer simply to develop a region. It is to ensure that your competitor does not control it first. Realpolitik teaches that, in this situation, human beings should be treated as terrain and economically valued according to the ground a population occupies rather than the people who occupy it.

In the affairs of empires, ethics always takes a back seat to economics.

That shift in priorities has consequences. Investment follows the mine, the transportation corridor, the processing facility, and the supply chain. Public health, education, and civil institutions become secondary, not necessarily because anyone wishes the local population harm, but because they no longer contribute directly to the short-term strategic objective.

Eastern Congo has experienced this dynamic before. During the era of King Leopold II, the Congo became the focus of intense competition among European powers during the Scramble for Africa. Once Leopold secured control, the territory was organized under a colonial model to extract rubber at an enormous human cost (Hochschild 1998). Today, the strategic resource is no longer rubber but cobalt, coltan, gold, and other critical minerals. The geopolitical context is different, but the underlying lesson remains relevant: when competition centers on what lies beneath the ground, the people living above it can become secondary to the contest.

That helps explain the current biodefense posture.

When wealthy nations respond to Ebola in eastern Congo, their first responsibility is naturally to protect their own citizens. There is nothing surprising about that. Border screening, surveillance, and preparedness receive sustained funding because they protect domestic populations. But those same governments invest far less consistently in the local public health systems that would stop outbreaks where they begin. Contact tracers go unpaid. Clinics run short of supplies. Countermeasures are developed only after an outbreak has become an international emergency.

This is not a conspiracy. It is a consequence of priorities.

Medical countermeasures do not flow solely according to disease burden or scientific need. They also follow political influence, economic interests, and strategic priorities. The communities living above some of the world’s most valuable mineral deposits receive the world’s attention when those minerals are at stake. They receive far less attention when what is at risk is merely the health of their citizens.

That is the lesson of the Bundibugyo outbreak.

The virus is exposing far more than weaknesses in outbreak response. It is revealing how geopolitical priorities shape the development of vaccines, therapeutics, and public health infrastructure long before the first patient becomes infected.

What Will Trigger the Response?

I don’t offer this as speculation. I offer it as an observation based on experience.

During the West African Ebola epidemic of 2014 to 2016, I worked on the front lines of the international response and watched, from the inside, how governments, regulators, industry, public health agencies, and the World Health Organization mobilized as the crisis unfolded.

For much of 2014, the epidemic spread through Guinea, Liberia, and Sierra Leone while the international response struggled to keep pace. Public health teams worked heroically, but resources, logistics, and political attention lagged behind the outbreak. Then the calculus changed. Ebola reached a hospital in Dallas. A nurse became infected in Madrid. What had been viewed as a regional humanitarian disaster suddenly became a perceived threat to Europe and North America.

Everything accelerated.

Resources flowed. Military logistics were deployed. Regulatory barriers fell. Research funding expanded. Clinical trials were launched. The United States sent thousands of military personnel to Liberia, and international public health agencies mobilized at a scale that would have been difficult to imagine only months earlier (CDC, n.d.; Henao-Restrepo et al. 2017).

That experience left me with an uncomfortable conclusion.

The current international system responds rapidly when an outbreak is perceived as threatening wealthy nations, not when it is causing the greatest suffering where it began. That is not cynicism. It is the pattern I observed firsthand, and it is consistent with the incentives that continue to shape global preparedness today.

If that pattern holds, the indicators to watch are not simply the number of deaths in eastern Congo. They are signs that the outbreak is approaching major transportation hubs and international travel networks. Sustained transmission in a city such as Kisangani or Kampala would change the global risk calculus. A travel-associated case with onward transmission in the Gulf States or Europe would change it further. A sustained chain of transmission in North America or Western Europe would almost certainly trigger an even larger international response.

By then, however, the world will once again be responding after the window for efficient containment has begun to close. Speaking more plainly, it will try to close the barn door after the horse has bolted.

That is the central irony.

From both a public health and a biodefense perspective, the least expensive place to stop an Ebola outbreak is where it begins. Every missed opportunity increases both the human and economic cost of containment. Waiting until a regional outbreak becomes an international security concern does not simply delay the response. It guarantees that the response will be larger, more expensive, and less effective than it needed to be.

The lesson extends far beyond Ebola.

In infectious disease, the periphery is never separate from the core. A preparedness strategy that tolerates neglect where outbreaks begin ultimately increases the risk to everyone.

Implications for countermeasure and biodefense policy

Assuming that this analysis is correct, several conclusions follow.

First, preparedness must become proactive rather than reactive. The world should not wait for an outbreak to become an international emergency before assembling the tools needed to contain it. Preparedness means maintaining surveillance systems, laboratory capacity, trained epidemiologists, emergency logistics, financing mechanisms, diagnostics, therapeutics, and vaccines before the next outbreak begins, not after it is already spreading.

Second, preparedness cannot be driven primarily by market size or the perceived threat to wealthy nations. Bundibugyo Ebola was identified nearly twenty years ago, yet it entered this outbreak without robust public health infrastructure, licensed vaccines or therapeutics, and with remarkably little dedicated research. That was not a failure of science. It was a failure of priorities. High-consequence pathogens should be evaluated according to the risk they pose, not simply the size of the commercial market they represent.

Third, outbreak response should be treated as essential infrastructure rather than emergency charity. Contact tracers, burial teams, laboratories, and frontline healthcare workers should never have to wait for emergency appropriations before they can begin their work. An $18 million funding gap that delays critical research and public health operations is not evidence that the world lacks resources. It is evidence that we have built the wrong financial architecture.

Fourth, governments need to stop treating critical-mineral policy and biosecurity policy as separate portfolios. They are deeply interconnected. One cannot pursue strategies to secure mineral supply chains while ignoring the instability that undermines public health in those same regions. An analyst who evaluates mineral agreements without considering their implications for health security, or who studies an Ebola outbreak without understanding the geopolitical competition surrounding it, is looking at only half the picture.

Finally, we should remember the central lesson of every Ebola outbreak. Vaccines and therapeutics are important additions to the public health toolbox, but they do not replace the foundations of outbreak control. Security, functioning public institutions, surveillance, community trust, and a trained public health workforce remain indispensable. When those foundations collapse, even the best medical technologies become far less effective.

That may be the most important lesson of the Bundibugyo outbreak. The greatest obstacle to controlling this epidemic is not the virus's biology. It is the failure to sustain the public health systems and preparedness infrastructure needed to contain it before it became an international emergency.

America First Requires Preparedness

There is one final implication, particularly for an America First foreign policy.

If the United States intends to secure long-term access to critical minerals in strategically important regions, then it also has a long-term interest in the stability and resilience of those regions. Public health preparedness should not be viewed as foreign aid or charity. It is part of the infrastructure that protects American supply chains, American industry, and ultimately American national security.

That does not mean nation building. It does not mean endless foreign aid. It does mean recognizing that surveillance systems, diagnostic laboratories, trained public health workers, and the ability to rapidly contain outbreaks where they begin are strategic assets. Investing in those capabilities before a crisis emerges is almost always less expensive than responding after an epidemic has spread across borders and threatens global supply chains.

This outbreak also illustrates the limits of international institutions. The World Health Organization can provide technical guidance, coordinate international partners, and support outbreak investigations. It cannot create security where armed conflict prevails. It cannot build functioning public institutions. And it cannot substitute for the sustained investment and long-term partnerships required to maintain public health preparedness in strategically important regions.

Critical minerals are truly a strategic priority for the United States. Therefore, preparedness in the regions that produce them must also become a strategic priority. That is not charity. It is prudent statecraft. It is sound biodefense. And, viewed through that lens, it is entirely consistent with an America First foreign policy.

Conclusion

The Bundibugyo outbreak continues not because this virus cannot be contained, but because the conditions required to contain it have been allowed to erode. We know how to stop Ebola. We have known for decades. What has been missing is not scientific or public health knowledge. It is the sustained commitment to building and maintaining public health systems, preparedness infrastructure, and political conditions that make containment possible.

The tragedy unfolding in eastern Congo exposes a larger truth. Preparedness does not develop solely in response to disease burden. It follows incentives. It follows markets. It follows politics. Increasingly, it follows the geopolitical competition for the critical minerals that power the modern world.

History suggests that the international response will accelerate only when an outbreak is perceived as threatening Europe or the Americas. By then, however, the opportunity for rapid, efficient containment has already begun to slip away. The world will spend more money, deploy more people, and accept greater risk than if it had invested earlier where the outbreak began.

There is a better way.

If critical minerals are a strategic priority for the United States, then the health and resilience of the communities that produce them must also be a strategic priority. That is not charity. It is not globalism. It is prudent statecraft. It is sound biodefense. And it is fully consistent with an America First policy that seeks to secure both the resources America needs and the stability required to keep those resources flowing.

The lesson of Bundibugyo Ebola extends far beyond one outbreak. The greatest threat is not simply the next virus. It is a preparedness system that mobilizes only after a crisis becomes impossible to ignore.

That is a policy choice.

It can also be changed.

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References

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