💉 The Ebola outbreak takes centre stage; Hantavirus recedes to the background; The world isn't ready for a pandemic
#606 | Hot and smoggy in India; The world won't get as hot as you thought; PAHO counts on Google to weed out disinformation
Hello, and welcome back to The Kable where yet another week brings yet another opportunity for yet another pandemic. How quickly hantavirus has moved off the front pages of pandemic opportunism, no? The flavour of the week now is Ebola. And not just any ole Ebola but the more exotic Bundibugyo version.
Before moving on to talking about ills of the world and other things, have you realised that there seems to be more disease around lately? Cholera, malaria, TB, flu, RSV, mpox, measles, dengue... all seem to be on the rise. Heck, true-blue, card-carrying meat-eaters in the US are turning vegan thanks to tick bites. Even “tiny” outbreaks that you rarely heard about previously are becoming more and frequent. Rare diseases are becoming increasingly less rare. Not a week goes by when some kind of fungal, or bacterial, or viral disease doesn’t affect some part of Africa. Sure, climate change has a part to play. As does air pollution. Even ultra-processed foods. Smoking and tobacco, for some. Alcohol. Sedentary lifestyles. But what is really at play here is Covid. A disease that is proven to cause immune dysfunction. A disease that affects your immune system so thoroughly that it leaves your body wide open for any other disease that wants to walk in. And it is the collective failure of our health authorities, our medical fraternity, our governments, our corporations, our return to work and school, our back to normal approach that has landed us in this place. Even in the face of growing evidence that we need clean air to mitigate this disease (and pollution but that’s a separate discussion), we’re doing nothing to implement clean air protocols in our schools and offices and indoor environments. And masking, hey, that’s for sheep. I’m free-spirited and can think for myself. I don’t follow the herd of maskers. I stand free, along with my 7 billion like-minded, free-spirited rebels. Not too long ago Ignaz Semmelweiss was forced out of medicine and shunted to a mental asylum because he insisted that doctors should practise the unheard-of custom of washing their hands before treating children in hospitals. Would the anti-maskers be okay with surgeons working on them in hospitals without disinfecting themselves today? Because rebels. Anyway, change is unlikely, but in the hope it does, some reading: Covid and a 49% higher risk of new-onset autoimmune-related diseases, the myth of “immunity debt,” increased risk of chronic pulmonary disease, cardiovascular disease, diabetes, kidney disease, mental health conditions, increased risk tolerance leading to more automobile accidents, and, ooh, flight issues. But buckle that seat belt tight, eh!
So yeah, poor hantavirus, relegated so quickly to the back pages. The UK is not sitting by though, having already secured for itself supplies of an experimental drug from Japan. Might the world have had more treatments for hantavirus, specifically the Andes hantavirus, by now? Possibly, if not for one of the scourges of the modern world, Donald Trump, and his administration that cut funding for a study on it. One last thing to add about hantavirus before we move on: it spreads primarily through contact with infected rodents, not via bites necessarily, but by inhaling aerosolised particles from rodent urine, droppings, or saliva. Touching contaminated surfaces and then touching the mouth, nose, or eyes is another way of exposure. And yet another means of contracting it is by consuming food or water contaminated with rodent excreta. All of these situations have been created, and enforced, by Israel in Gaza over the past three years. Sewage systems, water networks, buildings have all been destroyed. Combined with uncollected waste, rubble, and stagnant water across displacement camps, this has created optimal conditions for rapid proliferation of rodents and insects. And there is no capacity for pest control, sanitation, or healthcare in Gaza because Israel has ensured that. Since the beginning of 2026 alone, there have been more than 70,000 cases of ectoparasite infections and rodent-borne illnesses recorded in Gaza, with rodents contaminating food supplies, chewing through tents, and raising the risk of diseases including hantavirus pulmonary syndrome, leptospirosis, and rickettsial infections. And children who have lost the ability to dream. Israel still keeps weaponising even the barest of bare resources left in Gaza to breed more infectious diseases.
So, on to Ebola then. We began last week’s issue with the news about the outbreak of Ebola in Democratic Republic of Congo (DRC). And immediately thereafter, the Africa CDC declared it a pan-continental health emergency, the agency’s second-such declaration. The WHO stepped in too, declaring the Ebola outbreak a public health emergency of international concern, the third-such declaration in the last 6 years. Someone said something about escalating disease outbreaks post-Covid? Anyhoo, this is the 17th Ebola outbreak in DRC. Testing over the weekend confirmed that it is the Bundibugyo virus, which has had two reported outbreaks before: one in Uganda in 2007, and one in DRC (of course) in 2012. And the Bundibugyo virus doesn’t have any vaccines or treatments, just like the Sudan virus. When it comes to Ebola, only the Zaire virus has approved vaccines and drugs. But might we have had a treatment though? Possibly. But the world’s “smartest” man put paid to that. Here anyway is a list of treatments under development with no Musk involvement. There is a lot to unpack with this present outbreak, which within three days of being reported was already the third largest Ebola outbreak ever, and is well on its way to becoming the largest ever. The outbreak was first reported on April 24, but given the spread and the number of cases, researchers believe the disease has been circulating for weeks, maybe even months, and either went unnoticed or misdiagnosed. Easy to misdiagnose because there are no tests either for the Bundibugyo virus. Cases have also been reported in Uganda. Genomic sequencing of the outbreak reveals a more complex transmission pattern than a straightforward single-source outbreak. Instead of one linear chain, the viral genomes show branching transmission - multiple distinct clusters with geographic spread across Bunia, Katwa, and Uganda. This could indicate either multiple independent spillover events from the animal reservoir or a single introduction that went undetected long enough to establish several separate human-to-human transmission chains spreading in parallel. The pattern matters operationally: Ebola containment depends on contact tracing and ring vaccination, both of which become substantially harder with multiple active transmission hotspots. A dispersed, multi-focal outbreak suggests more locations requiring surveillance, possible undetected community transmission, and an outbreak potentially larger or older than initial assessments indicated. And we’re already seeing that in play on the ground. So, do we think Ebola is what the next pandemic will be? Just like we said with hantavirus, unlikely. We do think Ebola will cost us way more lives, and possibly take much, much longer to contain. But thankfully, there have been no reports of asymptomatic spread so far, or even in the past. At the moment, case counts, and deaths, are on a steep upward trajectory but Africa has shown several times in the past that she knows how to handle an Ebola outbreak even with very limited resources. And this time, the Africa CDC is fully present, and has support from the WHO, with CEPI, Gavi et al hopefully ready to jump in. So no, we don’t think this will become a pandemic.
Ebola isn’t the only thing rampant in DRC though. This year, there have been over 25,000 suspected cholera cases, over 71,000 suspected measles cases, and over 2,300 cases of bacterial meningitis. Not even counting mpox which is still doing the rounds across Africa with more than 250 confirmed cases, and one death, in the last three weeks. In Nigeria, an ongoing Lassa fever outbreak has seen the death toll rise to 191.
But enough with the disease. Let’s look at what else has been happening. The Africa CDC partnered with the Global Fund to strengthen health systems across Africa and further the continent’s self-reliance plan. The agency also launched a report demonstrating the investment potential for health R&D in Africa. How much is it, you ask? $668 billion in additional GDP over the next 20 years. Both of these announcements came on the sidelines of the ongoing World Health Assembly (WHA), at which the Pandemic Pact was not discussed or presented.
What did happen at the WHA though? Well, they agreed to discuss the Pandemic Pact later. Sometime later. They agreed to suspend the US’ voting rights if outstanding dues didn’t get paid, although considering the US has exited the WHO, why should they have voting rights anyway? They also condemned Iran’s attacks on Gulf states, while saying nothing about the attacks on Iran which necessitated Iran’s response. China, and to some degree South Africa, were the only countries to call out the US attack on Iran.
On the sidelines of the WHA, the African Medicines Agency (AMA) took a couple of large strides too: a partnership with the US Pharmacopeia (USP) for regulatory collaboration, and a collaboration agreement with the WHO to advance regulatory harmonisation in Africa.
Elsewhere PAHO partnered with Google “to expand access to trusted health information.” Hehehe. Google. One of the biggest purveyors of misinformation in the online space alongside Meta and whatever Space Karen wants to call his venture is what PAHO thinks will credibly disseminate reliable health information “while countering the spread of misinformation online.” Meanwhile, this is the kind of shit on YouTube that proliferates in the name of science.
There was stuff happening at the UN Security Council too. Bahrain continued again to try and get support to force an intervention in the Strait of Hormuz. And the UK said Iran should halt all attacks. The UK didn’t ask anybody to stop attacking Iran though. The best statement, with not even a hint of irony though, came from France who said the Council has a duty to protect civilians. Okay, nothing ironical in that but in the same statement France said “the Council must support efforts aimed at holding perpetrators of war crimes to account, including by the International Criminal Court.” Okay, the ICC did issue warrants against Benjamin Netanyahu and Yoav Gallant in November 2024. Initially, a French foreign ministry spokesperson said the country would act “in line with the ICC’s statutes.” Then, the French foreign ministry said that provisions for immunity from prosecution apply to Netanyahu and other Israeli leaders. The International Federation for Human Rights (FIDH) said France is lying because when the ICC issued a warrant against Vladimir Putin, France didn’t have any such diplomatic qualms. So, yeah, offer rhetorical support when it is politically cost-free, then retreat from it at every point when it requires something concrete. Then grab a Security Council pulpit and preach. Nous sommes très honorables.
In other news, Roche has partnered with the Medicines Patent Pool to increase access to its influenza antiviral medicine Xofluza in 129 countries. The deal will allow selected generic manufacturers to develop and supply lower-cost versions of the treatment.
Speaking of partnerships, Gilead also expanded its collab with the WHO to supply roughly 400,000 more doses of its treatment for visceral leishmaniasis. Gilead also inked yet another deal, this one worth $140 million, with South Korean API maker Yuhan. Gilead also continued to ignore MSF’s plea to sell HIV meds directly to them.
And we’re not done with death and other mysteries yet. In the US, four people died and emergency responders had to be quarantined because of exposure to “an unknown substance.”
China has denied entry visas to pigs and wild boar from the Philippines because of swine flu.
And for the last three years, we have been talking about the disease most likely to cause the next pandemic: bird flu. It has now been found for the first time in a polar bear on Svalbard, the same place that hosts the world’s seed vault, in case of world-ending apocalypse. And bird flu isn’t done changing form yet. A new study has found a reassortment of Eurasian, North American, and South American genes. Unfortunately, we have not been paying any heed on the scale we should be to bird flu. If a pandemic were to hit, we are not prepared. And unlike Ebola, unlike hantavirus, unlike Covid even, a bird flu pandemic would be pretty much disastrous. For humans, and for all kinds of animal and avian life.
And finally, for what it is worth, the UN General Assembly adopted a resolution saying countries are obligated to protect the environment from greenhouse gas emissions. The resolution has no legal bearing but at least it is a good moral victory to end this section with.
Stories Of The Week
Are we ready yet? Ready for what, the next pandemic? Hell, no! A new Global Preparedness Monitoring Board report says the world is not getting safer from pandemics. In fact, pandemic risk is rising faster than preparedness investment, leaving countries more exposed than they were after Covid.
The report, A World on the Edge: Priorities for a Pandemic-Resilient Future, tracks a decade of Public Health Emergencies of International Concern, from Ebola to Covid to mpox. Its verdict is blunt: outbreaks are becoming more frequent, more damaging, and harder to recover from. Health systems are under strain, economies are more fragile, societies are more polarised, and development assistance has fallen to levels not seen since 2009.
One of the sharpest warnings is around equity. Access to diagnostics, vaccines and treatments is not improving fast enough. Mpox vaccines reached affected low-income countries almost two years after the outbreak began, slower than the 17 months it took for Covid vaccines to arrive. Of course, there was only approved manufacturer who was more interested in selling to countries in the Global North who wanted stockpiles, so there’s that.
Ebola outbreaks, and Covid especially, also weakened trust in government, civil liberties and democratic norms, while politicised responses and attacks on scientific institutions have left societies less resilient for the next crisis.
AI and digital tools could help monitor threats and strengthen preparedness, but the report warns that without governance and safeguards, they could also deepen access gaps and weaken health security.
The GPMB sets out three priorities: create a permanent independent mechanism to monitor pandemic risk, finalise the Pandemic Pact (hehe), and secure financing for both preparedness and early response.
Simple then. Build trust. Manufacture equity. Work on following through. But first, a Pandemic Pact. Maybe before the next pandemic.
(GPMB)
Bottom line
Divided by borders, united by weather. Millions of people across India and Pakistan are sharing the same truth: pre-monsoon heat is becoming longer, earlier and deadlier. A new analysis by World Weather Attribution finds that human-caused climate change made the heatwave across northwestern India and Pakistan last month roughly three times more likely, and about 1°C hotter than it would have been in a pre-industrial climate.
The event is no longer rare. The study estimates that a 15-day April heatwave like this now has about a 20% chance of occurring in any given April. In plainer terms: this is becoming a one-in-five-year problem, not an exceptional weather anomaly.
The heat was brutal on the ground. From mid-April into May, several Indian cities crossed 46°C, with at least 37 heat-related deaths reported in India and 10 in Karachi. The heat also pushed electricity demand to record levels and compounded agricultural drought conditions across more than 1 million sq km.
The more worrying signal is timing. Extreme April heat is intensifying faster than May heat, which means South Asia is facing a longer danger window before the monsoon. Dry heat is arriving earlier, humid heat is compounding the risk later, and the season of survivable discomfort is turning into a season of serious public-health stress.
Heat Action Plans are helping, but the report says implementation remains uneven and too focused on emergency response. Outdoor workers, daily-wage earners, older adults, people in poor-quality housing and informal workers remain the most exposed. The funding problem is also basic: because heatwaves are not formally declared disasters in India and Pakistan, they are often excluded from disaster relief support.
The climate crisis of the future is already here for South Asia. Hospitals, farms, power grids, streets, homes are all now relics from the future.
(World Weather Attribution)
Glass half-full? Doesn’t matter even if it’s half-empty. Coz whatever is in it is gonna boil, baby, boil. But let’s begin with good news. Climate scientists are revising the old climate scenario playbook. The very worst-case pathway, the coal-heavy future that projected around 4.5°C of warming by 2100, now looks less likely. That is progress. Unfortunately, the best-case pathway is also slipping away, with even the most optimistic scenarios now expected to overshoot the Paris Agreement’s 1.5°C limit. The new proposed worst-case scenario sits closer to 3.5°C by the end of the century, while the “middle” path, roughly where the world is currently headed, lands near 3°C of warming. The planet is already about 1.3°C warmer than pre-industrial levels, and every extra tenth of a degree sharpens risks around heat, floods, water scarcity and ecosystem loss.
The grim bit: 1.5°C is now considered implausible without first overshooting it, then somehow pulling warming back down later through large-scale carbon removal. In the best-case scenario described by scientists, warming peaks around 1.7°C and may stay there for decades before any theoretical cooling happens.
Doesn’t mean the apocalypse has been cancelled. Emissions are still rising, action is still too slow, and climate feedbacks, from ocean heat release to forest carbon loss and cloud changes, could add further warming beyond human-controlled emissions. The window has narrowed, but the danger has not disappeared. Not that it matters much because by 2100, one pandemic or the other would’ve taken care of pretty much all of us. If not, there’s always Israel.
(Copernicus)
Long reads
It’s getting smoggy in here. Only one story here this week but wear a mask while reading this. Because it is about air pollution in India and how it is years of political denial that has brought it to the state it is in where redemption seems almost impossible.
(Drilled)
Oh, and Gopal Nair doesn’t want you to see this.
Excellent review of everything in health care