r/publichealth

This study just published in Risk Analysis is directly relevant to a debate that comes up a lot in this field: are we measuring access correctly, or are we measuring something that only loosely correlates with actual healthcare utilization?

Researchers at Cal Poly combined mobile phone mobility data with demographic and socioeconomic census data to model pharmacy foot traffic across LA County. Rather than relying on traditional geographic proximity metrics, they applied discrete choice theory to analyze where people actually go what they call *realized access* versus what's simply available nearby.

Here are the core finding:

• Nearly 98% of LA County residents had a pharmacy within 5km. Only 70% used one that close.
• Over a third of low-income residents visited pharmacies in low-income neighborhoods. Fewer than 7% sought care in higher-income areas.
• The pattern reflects strong social similarity in mobility — people consistently choose facilities in communities that demographically mirror their own.

This has direct implications for how we conduct needs assessments, allocate resources, and evaluate intervention effectiveness. If our access metrics don't account for social and behavioral determinants of utilization, we're likely underestimating unmet need in underserved populations and overestimating the impact of supply-side interventions like simply opening new facilities.

The researchers note the model extends beyond pharmacies to grocery stores and other essential services and could be particularly valuable for modeling access disruption during disaster events and public health emergencies.

A young girl washing her hands at an Ebola prevention checkpoint supported by UK aid at a Ugandan border crossing point with the Democratic Republic of the Congo, August 2019. Photo: DFID/Anna Dubuis via Wikimedia Commons, CC BY 2.0.

The ongoing Ebola outbreak in eastern Democratic Republic of the Congo and Uganda is a regional emergency with public number still catching up to the real picture in the field. The WHO has declared the outbreak a “Public Health Emergency of International Concern” and Africa’s CDC declared a similar public health emergency. Despite both of those declarations, we still are likely well behind the curve in terms of confirmed case counts.

The US CDC’s May 17^(th) update had listed 10 confirmed cases in the DRC, 336 confirmed cases, with 88 deaths and two imported cases confirmed in Uganda. Today’s update from Africa’s CDC had increased the death count to 106 and 395 suspected cases across the affected areas of the DRC like Bunia, Goma, Mongwalu, Butembo, and Nyakunde and Kampala, Uganda. The Associated Press reports that one of the infected is an American doctor and medical missionary in Bunia. The numbers are likely to be higher by morning (I’ll be keeping this post up to date with important new information on the outbreak). None of this is to say this should be treated like a COVID-level threat with the WHO noting it does not yet meet the definition of a pandemic emergency. The threat to the average person outside of the region is low. Heightened risk currently sits with the families, health workers, burial teams, patients, drivers, contact tracers, and whoever else can be pulled into the chain of transmission.

What’s causing the outbreak?

Before getting further into the current outbreak, it is worth remembering how and when Ebola entered the official record in the first place. WHO describes Ebola disease as first appearing in 1976 in two near-simultaneous outbreaks, one of the Sudan virus disease in Nzara, in what is now South Sudan, and the other of Ebola virus disease in Yambuku, in what is now the Democratic Republic of the Congo. The Yambuku outbreak, near the Ebola River, is the one that gave the disease its name. CDC’s outbreak history lists the 1976 DRC outbreak at 318 cases and 280 deaths (a fatality rate of 88%). The index case was treated at Yambuku Mission Hospital with an injection for possible malaria, and subsequent transmission followed through contaminated needles and syringes at the hospital and nearby clinics, as well as close personal contact.

This is Bundibugyo ebolavirus, as opposed to the better-known Zaire ebolavirus. Species is important here; I say that because when most people hear about Ebola, they’re likely to think of the West Africa outbreak or the 2018-2020 outbreak in North Kivu and Ituri. Those were Zaire ebolavirus outbreaks, and thankfully our modern response toolkit to combat Zaire ebolavirus now has a vaccine. Bundibugyo is different, most importantly in that there is no vaccine and no treatment beyond supportive care such as fluids, electrolytes, oxygen, constant monitoring, watching for secondary infections, and clinical hygiene. That puts an added strain on the already lean control machinery like isolation of cases, tracing contacts for 21 days, protecting health care workers with adequate PPE, and crucially, handling burials safely.

Why tracing an outbreak early is difficult

In an early epidemic, we often end up with a denominator problem in that counts of cases often lag behind the actual epidemic curve. This happens for a variety of reasons: people get sick before being tested, families bury someone before samples can be collected, healthcare workers get exposed before a disease even has a name, patients move closer to hospitals, contacts move around before tracing is even known to be needed, and any other reason imaginable for why a case may be missed. With Africa CDC already describing hundreds of suspected cases and over 100 deaths into the public phase of the outbreak, it seems that the response is working to reconstruct something that may have been moving around for quite some time, with late April being thought to be a decent starting point with a healthcare worker being identified as an early case. So while the confirmed numbers are useful, they’re almost always going to be underestimates the day they’re released.

How does this compare to 2014?

The 2014 comparison is useful, but it is not perfect. Seven days after announcement is not the same thing as seven days after spillover. One outbreak can burn quietly for weeks before being recognized, while another can be identified faster because the surveillance system is already primed. So the comparison should not be treated as a clean clock-to-clock match. What we can compare is the early public surveillance snapshot: what officials knew, what they were still chasing, and what kinds of warning signs were already visible.

WHO’s first public notice on March 23, 2014, described 49 cases and 29 deaths in Guinea, a 59% case fatality ratio. By March 27, WHO was reporting 103 suspected and confirmed cases, 66 deaths, four laboratory-confirmed cases in Conakry, four health-worker deaths, and suspected cases with deaths in Liberia and Sierra Leone among people who had traveled from Guinea. ECDC’s March 27 update described the outbreak as rapidly evolving and noted that supplies and logistics were still being mobilized.

So while the variant is different, the early shape of the current epidemic is not exactly more reassuring than previous outbreaks as we see high deaths relative to reported cases, health-worker deaths, funeral exposure, city involvement, border risk, and contact tracing trying to catch up to events that have already happened. That along with the fact that the current outbreak is Bundibugyo, with no licensed vaccine or treatment, makes me more concerned for those in the region.

Politics are not irrelevant

In 2014, the outbreak occurred while USAID and the CDC were still at a working capacity with regards to combating infectious diseases like Ebola. Even then, the response was late, messy, and inadequate. This outbreak is happening after DOGE spent most of 2025 cutting into USAID and US international health response capacity. Obviously that didn’t cause the outbreak, but it certainly changed the response environment for the worse. Especially having nerfed our Ebola research capacity. High-containment labs have incredibly harsh safety standards, and with Bundibugyo having no licensed vaccine and no specific therapeutic, shutting down one of the rare labs capable of doing safe work on Ebola is working in the wrong direction to say the least.

Where the outbreak could be going.

I had seen a story on twitter regarding a case in Kinshasa but I haven’t been able to confirm anything other than a person who tested negative. Goma and Kampala likely matter more at the moment. Goma is a large, mobile city on the Rwandan border, and it is currently under the control of the Rwanda-backed paramilitary group M23 movement. AFP-linked reporting says a confirmed case in Goma involved the wife of a man who died of Ebola in Bunia. She traveled to Goma after his death while already infected leading to the closure of some Goma-Gisenyi border crossings after the case was reported.

Uganda has reported two imported confirmed cases among people who traveled from the DRC, with no local transmission identified at the time of WHO’s report. One imported case is a warning. Two imported cases that do not obviously sit in one neat chain make me wonder what the DRC side has not reconstructed yet.

CDC is now trying to put some of its machinery back in motion as their May 18 briefing, confirmed the American case linked to work in the DRC, evacuation of other American and high-risk contacts to a quarantine facility Germany, enhanced screening and traveler monitoring for arrivals from DRC, Uganda, and South Sudan, and entry restrictions for non-U.S. passport holders who had been in those countries during the previous 21 days. The risk to the American public remains low.

What to watch out for

Over the next few days, I’ll be watching whether cases keep appearing in Goma, Butembo, Bunia, or other cities. Isolated introductions are one thing. Multiple urban chains are different. There’s also a need to keep an eye on Uganda for local transmission. Some imported cases are expected when people move across borders for care, work, or family reasons but any local spread in Kampala would change the story for the worse.

I’ll also be watching out for the gap between suspected cases, deaths, and confirmed cases to either widen or start to narrow depending on how much suspected cases outpace confirmatory testing. The count is supposed to move as testing catches up, but a widening gap would be a bad sign. I’ll be watching to see whether international support moves faster than the virus. Early signs are good with the ECDC having activated the EU Health Task Force, the IRC launched an emergency response in eastern DRC, and Africa CDC says it is working with partners to assess medical countermeasures and accelerate the necessary operational research.

I am reading the most recent WH release “2026 National Drug Control Strategy” for work and notice many of the administrations priorities focus on public health domains (evidence based treatment, public health data collection, etc) to combat the drug crisis.

My question is if Public Health is such a a need why did the administration categorize it under the non professional degrees? I do understand the economical logic behind the decision: loan amounts capped, universities will be forced to bring down their costs) but is that the only reason?!

I’m in public health and have been wanting to get my MPH degree for awhile and this decision deterred me big time because I don’t want to get into debt but reading this release, I realize it is a need and a priority!

Trying to converse about this with someone who may have some knowledge to what this administration is doing lol

It goes without saying that things aren’t great in the US right now, so I wanted to start a discussion and see how other countries are doing in comparison.

-What are your country’s current top public health initiatives, priorities, or challenges?
-Have you noticed an increase in the spread disinformation or skepticism as it relates to medicine or science? It’s certainly increased since COVID here in the US, but maybe not so much in other countries?
-Funding wise, are you seeing cuts to programs and/or research, or have things been status quo? Perhaps things are going well and there’s been an increase in funding?
-Are you noticing an influx of researchers/public health professionals from the US?
-Any exciting recent public heath advancements or wins?

I’m trying to get better at translating health guidance into language normal people will actually act on.

Not asking for patient-specific examples or proprietary campaign details. I’m more interested in patterns.

In your experience, what message, framing, or format genuinely changed behavior in a community you know well? Could be screening uptake, vaccine uptake, STI testing, smoking cessation, heat safety, air quality, follow-up visits, or something else.

And on the flip side: what sounded smart to professionals but landed badly with the public?

My working theory is that people often do not need more facts first. They need fewer decisions, a clearer next step, and a reason the action feels worth doing today.

WHO has officially declared the Bundibugyo virus disease (BVD) outbreak in the Democratic Republic of the Congo and Uganda a Public Health Emergency of International Concern (PHEIC). However, it does not meet the threshold of a pandemic emergency under the IHR.

The Numbers (as of May 16, 2026):

• 8 laboratory-confirmed cases, 246 suspected cases, and 80 suspected deaths in Ituri Province, DRC (across Bunia, Rwampara, and Mongbwalu health zones)
• 2 confirmed cases (1 death) in Kampala, Uganda, both in ICU and linked to travel from DRC, with no apparent epidemiological link to each other
• A suspected case in Kinshasa was ruled out by confirmatory testing
• At least 4 healthcare worker deaths from suspected viral hemorrhagic fever, so nosocomial transmission is a concern (as usual in these settings)

The initial sample positivity rate was unusually high (8/13, or about 62%), suggesting the true case count is likely much larger than reported. The affected area mirrors the geography of the devastating 2018–19 North Kivu/Ituri Ebola-Zaire epidemic, with the same compounding factors: conflict, humanitarian crisis, high population mobility, and informal health facilities.

The critical difference this time? There are no approved vaccines or therapeutics for Bundibugyo virus, unlike Ebola-Zaire strains (which have ERVEBO and mAb114/ZMapp). This is not the Zaire strain. Clinical trials for countermeasures are urgently called for.

This is a rapidly evolving situation with significant epidemiological uncertainty. The high positivity rate, healthcare worker deaths, and cross-border spread to Kampala within days of the initial cluster are all red flags. Watch this space closely.